ABSTRACT: We assessed treatment duration with selective serotonin reuptake inhibitors (SSRIs) among children and adolescents and investigated the association between treatment duration, age, sex, active ingredient, season of initiation, and reimbursement rate.
Data on reimbursed SSRIs dispensed to children and adolescents aged <18 years in noninstitutional settings in Finland from 1999 to 2005 were extracted from the National Prescription Register. The association between treatment duration and explanatory factors was analyzed using Cox proportional hazards models.
SSRIs were reimbursed for 3,710 (35.8%) male and 6,666 female (64.2%) patients from 1999 to 2004, of whom 3,853 (37.1%) received ≤ 100 days' supply. Age ≤ 11 years [adjusted hazard ratio (HR) 0.87; 95% confidence interval (CI), 0.80-0.94] and 12-15 years (HR 0.89; 95% CI 0.84-0.93) was associated with longer treatment duration compared with adolescents aged 16-17 years. Shorter treatment duration was associated with initiating treatment from September to November compared with the other seasons. Recipients of a higher reimbursement rate had longer treatment duration (HR 0.46, 95% CI 0.39-0.55) compared with those who received a lower reimbursement rate. Shorter treatment duration was weakly associated with use of fluvoxamine (HR 1.16; 95% CI 1.03-1.30) compared with fluoxetine.
Shorter treatment duration was less common among younger children, when initiated from September to November and among recipients of a higher reimbursement rate.
European Journal of Clinical Pharmacology 02/2012; 68(7):1109-17. · 2.85 Impact Factor
ABSTRACT: New and expensive medicines are a driving force behind growth in medicine costs, and policies promoting use of less expensive products have been widely introduced. This study investigated the short-term consequences of the restricted reimbursement of expensive statins (atorvastatin and rosuvastatin) on the use of statins in Finland.
Data on patients purchasing atorvastatin, rosuvastatin, or simvastatin in 2002-2007 were retrieved from the nationwide Prescription Register. Outcome measures included the time trend in the numbers of purchasers and initiators of different statins, the morbidities of new users before and after the new policy, and the proportion of users of expensive statins switching to other statins.
After the restriction, the numbers of purchasers of atorvastatin and rosuvastatin dropped, and atorvastatin and rosuvastatin were seldom prescribed as first-line therapy. Before the restriction, 20.9% of new users of atorvastatin and 18.4% of those of rosuvastatin had either coronary artery disease or familial hyperlipidemia. After the restriction the corresponding figures were 28.7% and 26.8%. After the restriction new users of atorvastatin and rosuvastatin were also more likely to use other cardiovascular medicines or antidiabetics or to have previous statin purchases. A total of 57.6% of those using atorvastatin and 49.2% of those using rosuvastatin before the restriction switched to a less expensive statin.
Restricted reimbursement of expensive statins decreased their use. It seems that after the policy new statin treatments have channeled appropriately. Although it is likely that the cost-containment aim of the policy was reached, health and long-term effects are not known.
Medical care 09/2010; 48(9):761-6. · 3.24 Impact Factor
ABSTRACT: The aim of this study was to analyze changes in the prevalence and incidence of antidepressant use among children and adolescents in Finland post October, 2003.
The sample comprised all children and adolescents in Finland aged < or =19.0 years (n = 27,676) who collected one or more reimbursed prescriptions for an antidepressant in noninstitutional and nonhospital settings between January, 1998, and December, 2005. Time-series models were used to compare antidepressant use 60 months before and 24 months after the health advisory issued by the Food and Drug Administration (FDA) in October, 2003.
The annual prevalence (users/1,000 youths) of antidepressant use increased from 5.24 in 2002 to 5.93 in 2005. There was an increase in the monthly incidence (users = 1,000 youths) of selective serotonin reuptake inhibitors (SSRIs) use (+0.02498), fluoxetine use (+0.00691), and sertraline use (+0.00727) post October, 2003. When considering preadvisory trends in antidepressant use, only fluoxetine use was higher than the predicted post October 2003, use (<0.001). The use of all other SSRIs was significantly lower than predicted.
In contrast to many other countries, the use of antidepressants continued to increase among children and adolescents in Finland post October, 2003. While the rate of fluoxetine use increased, there was a decline in the rate at which all other SSRIs were used.
Journal of child and adolescent psychopharmacology 04/2010; 20(2):145-50. · 2.59 Impact Factor
ABSTRACT: To analyze differences in the pattern of statin use among 10 consecutive yearly cohorts of new users in Finland.
Retrospective cohort study based on administrative claims data.
New users of statins from January 1, 1995, to December 31, 2004, were captured from a nationwide prescription register, and the pattern of statin use was observed until December 31, 2005. The association between year of statin initiation and persistence with statin therapy during the first year of statin use was modeled using Cox proportional hazards regression analysis with multivariable adjustment. The median adherence (proportion of days covered) was computed among patients who discontinued therapy during each 365-day interval since statin initiation.
In total, 490,024 new users of statins were identified. In the multivariable-adjusted model, discontinuation during the first year among initiators of statin use in 1996 and 1997 was similar to that in 1995 (hazard ratio [HR], 0.99; 95% confidence interval [CI], 0.95-1.03 in 1996; and HR, 1.01; 95% CI, 0.98-1.05 in 1997). Compared with the 1995 cohort, the 1998, 1999, 2000, 2001, 2002, 2003, and 2004 cohorts were less likely to discontinue statin use. Hazard ratios of discontinuation for the cohorts ranged from 0.91 (95% CI, 0.88-0.94) in 1998 to 0.80 (95% CI, 0.78-0.83) in 2004. There were no differences in adherence with respect to the duration of therapy among the yearly cohorts.
Compared with the 1995 cohort, 1-year persistence with statin therapy in Finland improved among new users of statins in 1998, and the improvement persisted up to 2004. Adherence to statin therapy remained stable among initiators from 1995 to 2004.
The American journal of managed care 02/2010; 16(2):116-22. · 2.46 Impact Factor
ABSTRACT: Preventive statin therapy is often recommended as lifelong treatment.
The aim of this study was to analyze persistence with statin therapy over a decade of use and to identify factors associated with its discontinuation.
Persistence with therapy among new users of statins in 1995 was followed up until December 31, 2005, in Finland using the nationwide drug reimbursement register. Cumulative persistence was analyzed using Kaplan-Meier analysis. A Cox regression model was applied to analyze associations of various baseline covariates with discontinuation. We further modeled the association of time-specific covariates by stratifying the duration of therapy in years and using a logistic regression in which those continuing therapy until the end of follow-up (persistent users) formed the reference group. Adherence, defined as the proportion of days covered by statins, stratified by the timing of discontinuation, was computed for the respective groups.
Of the 18,072 new statin users, 73.3% (n =13,254) were aged >54 years and 54.8% (n =9908) were men. Of this cohort, 43.9% (n = 7926) were using statins throughout and at the end of the tenth year. Sex was not associated with persistence at any point. In the Cox model, persons aged 45 to 74 years at initiation were more likely to continue statin use than younger or older age groups. Among those who still used statins after the fifth year of observation, the age difference was not observed in the logistic regression model. The use of 1, 2, 3, or > or =4 cardiovascular drugs before the initiation predicted continuation relative to no cardiovascular drug use (hazard ratio for discontinuation significantly <1.00 in all comparisons). Adherence was best (median 93.9%) among the persistent users.
The 10-year persistence with statin use in this general population was approximately 44%. Persons aged 45 to 74 years at initiation and those with at least 1 prescription for another cardiovascular medication were the most likely to continue statin therapy up to the fifth year.
Clinical Therapeutics 01/2008; 30 Pt 2:2228-40. · 2.32 Impact Factor