Antidepressant Prescription Practices in the Swiss Health Care System

Antidepressants (AD) are the most commonly prescribed psychopharmacological drugs and are primarily used for treating depression due to their mood-elevating effects. Also in Switzerland, AD is the largest class of all prescribed psychotropic drugs (~50%)¹.

In the last 10-20 years, AD prescription frequency has increased dramatically in industrialised countries². Long-term use and an increased prescription incidence are being discussed as potential reasons for this rise, but also inadequate health care practices might contribute to this situation. In Switzerland, evidence suggests that mild depression are oftentimes treated exclusively pharmacologically¹, despite national clinical guidelines that recommend psychotherapeutic treatment of mild to moderate depression³.

The AD-project aims at depicting the health care reality of AD prescriptions in Switzerland. Medical prescription practices will be analysed exploratively based on a database of electronic medical records of the Helsana health insurance. Following objectives that build upon each other are addressed: 

1. Description of the number of AD prescriptions a) over time, b) differentiated according to drug class, c) depending on the practitioner, and d) in consideration of sociodemographic and regional differences.
    
2. Description of characteristics of individual AD treatment courses as a function of a) treatment duration, b) type and frequency switching, c) combination therapy (augmentation, polypharmacy), and d) indicated accompanying examinations.
    
3. Based on the descriptive analyses, the third objective aims at appraising and evaluating prescription practices concerning guideline adherence employing selected quality indicators. 
    
4. Association between developed quality indicators and outcomes: a) Hospitalisation and b) mortality.
    

Datenbasis & Analyse:

Electronic health claims data of the year 2016 will be used for the proposed analyses. The database reflects the dispensing of medication for each insuree.  Approximately 70% of 1.2 million individuals with basic insurance received prescriptions between 2011 and 2014⁴.

AD drug class will be identified using the anatomic-therapeutic-chemical classification (ATC-codes) of the WHO: 

1. N06AA: tricyclic ADs (TCAs)

2. N06AB: selective serotonin reuptake inhibitors (SSRIs)

3. N06AF/G: monoamine oxidase inhibitors (MAOIs)

4. N06AX: atypical ADs (e.g., tetracyclic ADs, SNRIs, SNDRI)

Cooperation:

Division of Health Services Research, Helsana, Zurich. 
Department of Primary Care, University of Zurich.

References:

[1] Schuler D, Burla L. Psychische Gesundheit in der Schweiz. Monitoring 2012 (Obsan Bericht 52). Schweizerisches Gesundheitsobservatorium. Neuchâtel: 2012.

[2] Olfson M, Marcus SC. National patterns in antidepressant medication treatment. Arch Gen Psychiatry. 2009;66(8):848–856.
[3] DGPPN, BÄK, KBV, et al. für die Leitliniengruppe Unipolare Depression. S3-Leitlinie/Nationale VersorgungsLeitlinie Unipolare Depression. DGPPN, ÄZQ, AWMF. Berlin, Düsseldorf: 2015.

[4] Biétry F, Schur N, Pfeil A, et al. Helsana-Arzneimittelreport für die Schweiz 2015. Auswertungsergebnisse der Helsana Arzneimitteldaten aus den Jahren 2011 bis 2014. 2015.