Sleeping Pills Use Among Adults in Israel

Sleeping Pills Use Among Adults in Israel

VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 3 4 7 – A 7 6 6 A529 who were still on treatment on three-monthly LAT drops after every three months t...

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VA L U E I N H E A LT H 1 9 ( 2 0 1 6 ) A 3 4 7 – A 7 6 6

A529

who were still on treatment on three-monthly LAT drops after every three months to the level of PP1M. In an additional scenario it was assumed that the proportion of patients who were on three-monthly treatment drops after three months to the level of patients who were on PP1M after one month, and then mimics the remainder of the PP1M survival curve. Mean treatment duration in the first twelve months was calculated as area under the Kaplan-Meier curve of patients still on treatment.  Results: Treatment continuity was higher for three-monthly LAT versus one-monthly and bi-weekly. Mean number of treatment days for three-monthly LAT in Belgium and the Netherlands was 189 and 249 days, respectively. Percentage increase in time on treatment for three-monthly LAT was 28% versus PP1M and 57% versus RM in Belgium, 15% versus PP1M and 46% versus RM in the Netherlands. In the additional scenario, percentage increase in time on treatment for threemonthly LAT was 32%, 18% versus PP1M and 61%, 50% versus RM in Belgium and the Netherlands, respectively.  Conclusions: This study demonstrates that patients who will be treated with three-monthly LAT show higher treatment continuity versus one-monthly or bi-weekly LAT. The longer the administration interval, the longer patients will continue their treatment.

ants (from 1 in Turkey to 30 in Switzerland), costs spent for mental health (% from healthcare) also differ significantly from 2 % (Bulgaria) to almost 14 % (UK). Average European costs for pharmacotherapy (ATC groups N3-N7) is 25 Euro/capita (2013 data); from 6 € in Russia to 57 € in Switzerland. Since 2009 the penetration of atypical antipsychotics steadily increases across Europe from 48 % among all antipsychotics (2009) to 56 % (2013). We however found differences in individual countries (46 % penetration in Slovenia; 69 % penetration in Hungary). The average annual European consumption of antidepressants is 18 units per capita (2 units in Russia; 42 units in the UK). SSRIs represent approximately 50 % of all antidepressants in the majority of countries. Penetration of pharmacotherapy for dementia (ATC group N7D1) is poor across Europe except Finland and Greece. In almost all countries it is below 50 % if a hypothetical common prevalence of 1.17 % is assumed.  Conclusions: Our findings indicate unequal access, treatment penetration and allocation of financial resources across 29 evaluated European countries.

PMH44 Sleeping Pills Use Among Adults in Israel

Schwalm M, Miotti H, Hellard C, Bounit L, Trehony J, Jouaville SL IMS HEALTH, Boulogne Billancourt, France

Cohen A, Porath A, Stein - Reisner O Maccabi Healthcare Services, Tel-Aviv, Israel

Objectives: A recent study looking at nearly 10 years of medical records in a Canadian EMR-database showed that only 55 percent of all antidepressant prescriptions were given to patients to treat depression. The remaining 45 percent were prescribed to treat other conditions, including anxiety disorders, insomnia, pain, and panic disorders. We replicated this study in France analyzing the prevalence of treatment indications for antidepressants and assessing temporal trends in antidepressant prescribing for depression.  Methods: This study used data from IMS Health EMR-database France, an electronic medical record (EMR) and prescribing database of 1200 primary care physicians in community-based, fee for-service practices in France. This study included all prescriptions for all antidepressants, written for adults between January 1, 2006, and December 31, 2015. Physicians had to document at least 1 treatment indication per prescription. Diagnoses for depression were also researched in the EMR of the patients.  Results: During the study period, 1.8 million antidepressant prescriptions (1.9% of all prescriptions) were written by 685 physicians for 251 645 patients. About 60 % of antidepressant prescriptions were indicated for depression. Physicians also prescribed antidepressants for anxiety disorders (12%). Insomnia and pain summarized less than 2% of patients as opposed to 10% and 6% respectively in the Canadian study. The fourth most important indication associated with a prescription of antidepressant was drug dependence (2%). Between 2006 and 2015, the number of antidepressant prescribed was roughly constant although there were differences among classes. However, in the same period, similarly to the Canadian study, we found that the percentage of antidepressants prescribed for depression decreased  Conclusions: These results indicate that, in France as well as in Canada, the mere presence of an antidepressant prescription is a poor proxy for depression treatment.

Objectives: Sleep disorders and sleep deprivation are common phenomena that can hinder daily functioning, and affect physical and mental health. In the last two decades reports suggest an increase in the number of prescription and use of sleeping pills. It is estimated that in the U.S. about 3.5% of adults reported using sleeping pills in one month period in 2009- 2010, compared to only 2% in 1999-2000. We assessed the use of sleeping pills amongst adults in Israel.  Methods: The sample included all Maccabi Health Services (the second largest HMO in Israel) adults (> 18) between 2010- 2014. Users were members who were prescribed and who purchased at least one prescription. Chronic users were defined as members who were prescribed and purchased sleep medication at least once each year.  Results: We found a steady increase in the rate of sleeping pills users, from 41/1,000 in 2010 to 55/1,000 in 2014. An increase was found in the average treatment duration, from 157 days in 2010 to 177 in 2014. There was a 187% increase among members aged 18-45, 137% among members aged 45-65, and no increase among members over 65. Women use sleeping pills for a longer duration. There was no increase in the average of physician visits, nor in the total medications cost. The chronic users’ rate decreased during the years studied from 20.3/1,000 to 18.6/1,000. There was no significant difference between males and females in this group. We also found no difference between the two populations in terms of morbidity measured via physician visits and hospitalizations.  Conclusions: In a large representative sample of Israelis, we found an increasing rate of 55/1,000 sleeping pills users. The rate of chronic users however, was found to decrease. The largest increase was found in younger random users. PMH45 Examining The Relationship Between Suicidal Ideation, Depression and Selected Chronic Diseases Using The Nhanes Dataset Shalhoub H1, Rafael Albertorio-Díaz J2, Reaney M3 & Bentley University, LYNN, MA, USA, 2Center for Disease Control and Prevention, Hyattsville, MD, USA, 3ERT, Peterborough, UK

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Objectives: Suicide is a leading cause of death in many countries around the globe. Studies have found that people with chronic conditions (CC) have higher rates of suicide and suicidal ideation (SI), ranging anywhere from 10% to 40%. Depression is a risk factor for SI. As such, understanding the relative incidence of depression and SI in the general population compared to those with various CC is essential. This study thus aimed to estimate the prevalence of SI among adults with CC and to identify the relationship between CC, SI, and depression severity.  Methods: A quantitative analysis was conducted using six years of publicly available data from the US Center for Disease Control NHANES survey (2007-2012). The sample (n= 8,944) contained survey respondents 18 years and older. Depression and SI were measured using the patient health questionnaire (PHQ 8 and 9). Five CCs were assessed: arthritis, cancer, diabetes, hypertension and any other heart condition.  Results: 2.8% of the adult US population reported experiencing SI. SI was higher among people with CC, particularly adults with diabetes (4.5%) and arthritis (3.5%). Minor depression was also more prevalent among adults with diabetes (19.7%) and arthritis (19.1%). The number of co-morbidities did not impact rates of SI but did impact rates of depression (2 or more co-morbidities, 10.44%, p< 0.01). There was a positive correlation between depression severity and SI, with the highest rates of SI in the moderate to severe depression group (21.64%, p< 0.01).  Conclusions: SI among adults with CC is prevalent. People with CC experience more depression, but not always higher SI. People with diabetes have the highest prevalence of SI and depression. Due to the already known association between SI and suicide, the presented work is relevant for both, routine clinical care and for clinical research involving patients with arthritis, cancer, diabetes and heart conditions. PMH46 Mental Health - Costs and Treatment Penetration Across Europe Skoupa J, Hambalek J Czech Health-Economy Society, Prague, Czech Republic

Objectives: Mental health disorders are becoming important drivers in costs and resource use among non-communicable diseases. This trend will continue due to aging population. The authors evaluated pharmacotherapy costs, accessibility and treatment penetration for specific mental health disorders (schizophrenia, depression and dementia) across Europe.  Methods: Based on published statistics and IMS data we calculated No. of mental health specialists, resource use and medication penetration in 29 European countries. Penetration was calculated in standard units per capita.  Results: There is a wide range of psychiatrists per 100 000 inhabit-

PMH47 Treatment Indications for Antidepressants Prescribed in Primary Care in France, 2006–2015

PMH48 Feasibility, Reliability and Validity of The Decision Tool Unipolar Depression (DTUD) In Identifying Patients with Major Depressive Disorder in Need of Highly Specialized Care van Krugten FC1, Kaddouri M1, Goorden M1, van Balkom AJ2, Ruhé HG3, van Schaik DJ2, van Oppen P2, Hakkaart-van Roijen L1 1Erasmus University Rotterdam, Rotterdam, The Netherlands, 2VU University Medical Centre, Amsterdam, The Netherlands, 3University Medical Centre Groningen, Groningen, The Netherlands

Objectives: In order to aid clinicians in the early identification of patients with major depressive disorder (MDD) in need of highly specialized care, we developed the Decision Tool Unipolar Depression (DTUD). The aim of this study was to assess the feasibility, reliability and validity of the DTUD in patients with a primary diagnosis of MDD.  Methods: A total of 243 outpatients who were referred for treatment to a general psychiatric or highly specialized treatment centre were studied. The duration of completion and content clarity of the DTUD were used as indicators of feasibility. Inter-rater reliability was assessed using pairs of independent ratings (n= 54). To assess convergent validity, the Maudsley Staging Method (MSM), the Dutch Measure for quantification of Treatment Resistance in Depression (DM-TRD) and the five-level EuroQol five-dimensional questionnaire (EQ-5D-5L) were administered. A receiver operator characteristic (ROC) curve was constructed to assess the criterion validity.  Results: The average completion time of the DTUD was 4.5 min (SD= 2.7), and the content of the total set of items was judged as clear in 94.7% of all evaluations. Krippendorff’s alpha values of the individual items and total score ranged from 0.686 to 0.913, indicating acceptable inter-rater reliability. The pattern of correlations between the total DTUD score and total MSM (rs= 0.466, P= 0.000), DM-TRD (rs= 0.525, P= 0.000), and EQ-5D-5L (-0.649, P= 0.000) scores supported convergent validity. A maximum Youden index (J= 0.494) was obtained at a cut-off score of ≥ 5. This cut-off score revealed a sensitivity of 0.67 (95% CI 0.52–0.79) and a specificity of 0.83 (95% CI 0.73–0.90).  Conclusions: The DTUD provides an easily used, reliable and sufficiently valid tool for the identification of patients with MDD in need of highly specialized care. Its use in clinical practice will guide in the assignment of patients with MDD to the most appropriate treatment setting. PMH49 Early Indicators of Patients with Major Depressive Disorder in Need of Highly Specialized Care: A Systematic Review van Krugten FC1, Kaddouri M1, Goorden M1, van Balkom AJ2, Bockting CL3, Peeters FP4, Hakkaart-van Roijen L1 1Erasmus University Rotterdam, Rotterdam, The Netherlands, 2VU University Medical Centre, Amsterdam, The Netherlands, 3Utrecht University, Utrecht, The Netherlands, 4Maastricht University, Maastricht, The Netherlands

Objectives: Early identification of patients with major depressive disorder (MDD) who cannot be managed by general psychiatric services and require highly specialized