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Treatment Patterns and Costs in Patients With Generalised Anxiety Disorder: One-Year Retrospective Analysis of Data From National Registers in Sweden

Published online by Cambridge University Press:  26 April 2012

R. Sandelin ,
J. Kowalski ,
E. Ahnemark  and
C. Allgulander
R. Sandelin*
Affiliation:
Pfizer AB, Vetenskapsvägen 10, 191 90Sollentuna, Sweden
J. Kowalski
Affiliation:
Karolinska Institutet, 141 86Stockholm, Sweden
E. Ahnemark
Affiliation:
Pfizer AB, Vetenskapsvägen 10, 191 90Sollentuna, Sweden
C. Allgulander
Affiliation:
Karolinska Institutet, 141 86Stockholm, Sweden
*
⁎Corresponding author. Tel.: +46 768892278, fax: +46 855052010. E-mail address: rebecka.sandelin@pfizer.com (R. Sandelin).
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Abstract

Purpose

To investigate medication use, direct healthcare costs and comorbidities in patients with generalised anxiety disorder (GAD) within specialised care in Sweden 2006–2007.

Methods

A retrospective study was conducted using data from the National Patient Register and the Swedish Prescribed Drug Register. All patients with a primary GAD (ICD-10) diagnosis in 2006 were followed for 12 months to study medication use and health care consumption. Resource use was evaluated from the number of hospitalisation episodes, number of visits to outpatient care and medication dispensed. Costs were calculated by multiplying the number of visits and hospitalisation episodes with the corresponding unit costs. Descriptive statistics were used for all analyses.

Results

Three thousand seven hundred and one patients with a primary GAD diagnosis were included in the study. Thirty-four percent of the patients (n = 1246) had at least one secondary comorbid diagnosis. SSRIs/SNRIs were the most commonly dispensed medications, followed by benzodiazepine-anxiolytics, hypnotics and antihistamines. The mean number of treatment days for all medications prescribed and dispensed was highest (1144 days) for elderly women aged 65 years or more (treatment days per patient could exceed 365 days due to multiple concomitant medication use). Elderly patients were frequently prescribed benzodiazepine-anxiolytics (n = 92/117 men [79%]; n = 238/284 women [84%]) and hypnotics (n = 70 men [60%]; n = 178 women [63%]) compared to the overall study population (n = 612/1303 men [47%] and n = 935/2398 women [39%], respectively). GAD-related direct costs accounted for 96% of all direct costs. Mean number of hospitalisation days and corresponding costs were high (19 days; SEK 92,156; n = 358 [9.7%]) in relation to medication (SEK 5520; n = 3352 [91%]) and outpatient costs (SEK 7698; n = 3461 [94%]).

Conclusions

The high rate of polypharmacy, significant psychiatric comorbidity and widespread use of benzodiazepine-anxiolytics and medications not indicated for GAD suggest that the disease burden is high. Total direct costs associated with the disease were high but still likely to be underestimated.

Keywords

Generalised anxiety disorderMedical record linkagePharmacoepidemiologyCostComorbidity
Type
Original article
Information
European Psychiatry , Volume 28 , Issue 2 , February 2013 , pp. 125 - 133
Copyright
Copyright © Elsevier Masson SAS 2013

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References

Allgulander, C.Novel approaches to treatment of generalized anxiety disorder. Curr Opin Psychiatry 2010;23:37–42.CrossRefGoogle ScholarPubMed
Allgulander, C., Nilsson, B.A nationwide study in primary health care: one out of four patients suffers from anxiety and depression. Lakartidningen 2003;100:832–838.Google ScholarPubMed
Allgulander, C., Nutt, D.Benzodiazepines. In: Stolerman, I., Lader, M. editors. Encyclopedia of psychopharmacology 1st ed. Heidelberg: Springer-Verlag; 2010. 218–223.Google Scholar
Ansseau, M., Fischler, B., Dierick, M., Mignon, A., Leyman, S.Prevalence and impact of generalized anxiety disorder and major depression in primary care in Belgium and Luxemburg: the GADIS study. Eur Psychiatry 2005;20:229–235.CrossRefGoogle ScholarPubMed
Baldwin, D.S., Waldman, S., Allgulander, C.Evidence-based pharmacological treatment of generalized anxiety disorder. Int J Neuropsychopharmacol 2011;14(5):697–710.CrossRefGoogle ScholarPubMed
Bandelow, B., Zohar, J., Hollander, E., Kasper, S., Moller, H.J., Allgulander, C.et al.World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the pharmacological treatment of anxiety, obsessive-compulsive and post-traumatic stress disorders - first revision. World J Biol Psychiatry 2008;9:248–312.Google ScholarPubMed
Beekman, A.T., de Beurs, E., van Balkom, A.J., Deeg, D.J., van Dyck, R., van Tilburg, W.Anxiety and depression in later life: co-occurrence and communality of risk factors. Am J Psychiatry 2000;157:89–95.CrossRefGoogle ScholarPubMed
Belanger, L., Ladouceur, R., Morin, C.M.Generalized anxiety disorder and health care use. Can Fam Physician 2005;51:1362–1363.Google ScholarPubMed
Bereza, B.G., Machado, M., Einarson, T.R.Systematic review and quality assessment of economic evaluations and quality-of-life studies related to generalized anxiety disorder. Clin Ther 2009;31:1279–1308.CrossRefGoogle ScholarPubMed
Carter, C.S., Maddock, R.J.Chest pain in generalized anxiety disorder. Int J Psychiatry Med 1992;22:291–298.CrossRefGoogle ScholarPubMed
Carter, R.M., Wittchen, H.U., Pfister, H., Kessler, R.C.One-year prevalence of subthreshold and threshold DSM-IV generalized anxiety disorder in a nationally representative sample. Depress Anxiety 2001;13:78–88.CrossRefGoogle Scholar
Chang, C.M., Wu, E.C., Chang, I.S., Lin, K.M.Benzodiazepine and risk of hip fractures in older people: a nested case-control study in Taiwan. Am J Geriatr Psychiatry 2008;16:686–692.CrossRefGoogle ScholarPubMed
Chou, K.L.Age at onset of generalized anxiety disorder in older adults. Am J Geriatr Psychiatry 2009;17:455–464.CrossRefGoogle ScholarPubMed
Culpepper, L.Generalized anxiety disorder and medical illness. J Clin Psychiatry 2009;70(Suppl. 2):20–24.CrossRefGoogle ScholarPubMed
Davidson, J.R., Bose, A., Korotzer, A., Zheng, H.Escitalopram in the treatment of generalized anxiety disorder: double-blind, placebo controlled, flexible-dose study. Depress Anxiety 2004;19:234–240.CrossRefGoogle ScholarPubMed
Davidson, J.R., Zhang, W., Connor, K.M., Ji, J., Jobson, K., Lecrubier, Y.et al.A psychopharmacological treatment algorithm for generalised anxiety disorder (GAD). J Psychopharmacol 2010;24:3–26.CrossRefGoogle Scholar
Gelenberg, A.J., Lydiard, R.B., Rudolph, R.L., Aguiar, L., Haskins, J.T., Salinas, E.Efficacy of venlafaxine extended-release capsules in nondepressed outpatients with generalized anxiety disorder: a 6-month randomized controlled trial. JAMA 2000;283:3082–3088.CrossRefGoogle ScholarPubMed
Goodwin, R.D., Stein, M.B.Generalized anxiety disorder and peptic ulcer disease among adults in the United States. Psychosom Med 2002;64:862–866.Google ScholarPubMed
Hoffman, D.L., Dukes, E.M., Wittchen, H.U.Human and economic burden of generalized anxiety disorder. Depress Anxiety 2008;25:72–90.CrossRefGoogle ScholarPubMed
Katzman, M.A.Current considerations in the treatment of generalized anxiety disorder. CNS Drugs 2009;23:103–120.CrossRefGoogle ScholarPubMed
Kennedy, B.L., Schwab, J.J.Utilization of medical specialists by anxiety disorder patients. Psychosomatics 1997;38:109–112.CrossRefGoogle ScholarPubMed
Kessler, R.C., Andrade, L.H., Bijl, R.V., Offord, D.R., Demler, O.V., Stein, D.J.The effects of co-morbidity on the onset and persistence of generalized anxiety disorder in the ICPE surveys. International Consortium in Psychiatric Epidemiology. Psychol Med 2002;32:1213–1225.Google ScholarPubMed
Kessler, R.C., DuPont, R.L., Berglund, P., Wittchen, H.U.Impairment in pure and comorbid generalized anxiety disorder and major depression at 12 months in two national surveys. Am J Psychiatry 1999;156:1915–1923.Google ScholarPubMed
Kessler, R.C., Wang, P.S.The descriptive epidemiology of commonly occurring mental disorders in the United States. Annu Rev Public Health 2008;29:115–129.CrossRefGoogle ScholarPubMed
Lieb, R., Becker, E., Altamura, C.The epidemiology of generalized anxiety disorder in Europe. Eur Neuropsychopharmacol 2005;15:445–452.CrossRefGoogle ScholarPubMed
Liu, X., Ye, W., Watson, P., Tepper, P.Use of benzodiazepines, hypnotics, and anxiolytics in major depressive disorder: association with chronic pain diseases. J Nerv Ment Dis 2010;198(8):544–550.CrossRefGoogle ScholarPubMed
Mets, M.A., Volkerts, E.R., Olivier, B., Verster, J.C.Effect of hypnotic drugs on body balance and standing steadiness. Sleep Med Rev 2010;14:259–267.CrossRefGoogle ScholarPubMed
Mojtabai, R., Olfson, M.National trends in psychotropic medication polypharmacy in office-based psychiatry. Arch Gen Psychiatry 2010;67:26–36.CrossRefGoogle ScholarPubMed
Munk-Jorgensen, P., Allgulander, C., Dahl, A.A., Foldager, L., Holm, M., Rasmussen, I.et al.Prevalence of generalized anxiety disorder in general practice in Denmark, Finland, Norway, and Sweden. Psychiatr Serv 2006;57:1738–1744.CrossRefGoogle ScholarPubMed
National Institute for Health and Clinical Excellence (NICE). Clinical guideline 22. Anxiety (amended); 2007. Available from: http://www.nice.org.uk/nicemedia/pdf/CG022NICEguidelineamended.pdf.Google Scholar
Nutt, D., Argyropoulos, S., Hood, S., Potokar, J.Generalized anxiety disorder: a comorbid disease. Eur Neuropsychopharmacol 2006;16(Suppl. 2):S109–S118.CrossRefGoogle ScholarPubMed
Pollack, M.H.Refractory generalized anxiety disorder. J Clin Psychiatry 2009;70(Suppl. 2):32–38.CrossRefGoogle ScholarPubMed
Porensky, E.K., Dew, M.A., Karp, J.F., Skidmore, E., Rollman, B.L., Shear, M.K.et al.The burden of late-life generalized anxiety disorder: effects on disability, health-related quality of life, and healthcare utilization. Am J Geriatr Psychiatry 2009;17:473–482.CrossRefGoogle ScholarPubMed
Revicki, D.A., Brandenburg, N., Matza, L., Hornbrook, M.C., Feeny, D.Health-related quality of life and utilities in primary-care patients with generalized anxiety disorder. Qual Life Res 2008;17:1285–1294.CrossRefGoogle ScholarPubMed
Rickels, K., Zaninelli, R., McCafferty, J., Bellew, K., Iyengar, M., Sheehan, D.Paroxetine treatment of generalized anxiety disorder: a double-blind, placebo-controlled study. Am J Psychiatry 2003;160:749–756.CrossRefGoogle ScholarPubMed
Roy-Byrne, P.P., Wagner, A.Primary care perspectives on generalized anxiety disorder. J Clin Psychiatry 2004;65(Suppl. 13):20–26.Google ScholarPubMed
Ruscio, A., Chiu, W., Byrne-Roy, P., Stang, P., Stein, D., Wittchen, H.U.et al.Broadening the definition of generalized anxiety disorder: effects on prevalence and associations with other disorders in the National Comorbidity Survey Replication. J Anxiety Disord 2007;21:662–676.CrossRefGoogle ScholarPubMed
Science Daily Science Reference Library. Rockville, MD, United States; 2011. http://www.sciencedaily.com/articles/p/psychoactive_drug.htm.Google Scholar
Södra Regionvårdsnämnden Regionala priser och ersättningar för Södra sjukvårdsregionen 2008; 2007. Available from: http://www.skane.se/upload/Webbplatser/Sodra%20regionvardsnamnden/prislista/2008/helaprislistan2008.pdf.Google Scholar
Souetre, E., Lozet, H., Cimarosti, I., Martin, P., Chignon, J.M., Ades, J.et al.Cost of anxiety disorders: impact of comorbidity. J Psychosom Res 1994;38(Suppl. 1):151–160.CrossRefGoogle ScholarPubMed
Sveriges Kommuner och Landsting. Förteckning E för perioden 2007-01-01 - 2009-12-31 till riksavtalet för utomlänsvård, dnr 2006/0804; 2006. Available from: http://websesam.jll.se/diariet/files/42a4eb49-1b43-43f3-97aa-4c0ed952c681.pdf.Google Scholar
Swedish Council on Health Technology Assessment. Treatment of anxiety disorders: a systematic review. Report No. 171/1+2. 2005.Google Scholar
Swedish Council on Health Technology Assessment. Treatment of insomnia in adults [in Swedish]. Report No. 199. 2010.Google Scholar
The Swedish Board of Health and Welfare. The Prescribed Drug Register, 2005–2011.Google Scholar
The Swedish Board of Health and Welfare. Socialstyrelsen.se/statistik/statistikdatabas Diagnoser i slutenvård (Diagnosis of inpatient visits). 2011.Google Scholar
Wittchen, H.U.Generalized anxiety disorder: prevalence, burden, and cost to society. Depress Anxiety 2002;16:162–171.CrossRefGoogle ScholarPubMed
Wittchen, H.U., Zhao, S., Kessler, R.C., Eaton, W.W.DSM-III-R generalized anxiety disorder in the National Comorbidity Survey. Arch Gen Psychiatry 1994;51:355–364.CrossRefGoogle ScholarPubMed
Wittchen, H.U., Carter, R.M., Pfister, H., Montgomery, S.A., Kessler, R.C.Disabilities and quality of life in pure and comorbid generalized anxiety disorder and major depression in a national survey. Int Clin Psychopharmacol 2000;15:319–328.CrossRefGoogle ScholarPubMed
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