Medication economic burden of antidepressant non-adherence in Spain

Eduardo Gutiérrez-Abejón; M Aránzazu Pedrosa-Naudín; Diego Fernández-Lázaro; F Javier Alvarez

doi:10.3389/fphar.2023.1266034

Medication economic burden of antidepressant non-adherence in Spain

Front Pharmacol. 2023 Nov 14:14:1266034. doi: 10.3389/fphar.2023.1266034. eCollection 2023.

Authors

Eduardo Gutiérrez-Abejón^{1

2

3

4}, M Aránzazu Pedrosa-Naudín³, Diego Fernández-Lázaro^{5

6}, F Javier Alvarez^{1

7}

Affiliations

¹ Pharmacological Big Data Laboratory, Department of Cell Biology, Genetics, Histology and Pharmacology, Faculty of Medicine, University of Valladolid, Valladolid, Spain.
² Valladolid Este Primary Care Department, Valladolid, Spain.
³ Pharmacy Directorate, Castilla y León Health Council, Valladolid, Spain.
⁴ Facultad de Empresa y Comunicación, Universidad Internacional de la Rioja (UNIR), Logroño, Spain.
⁵ Department of Cellular Biology, Genetics, Histology and Pharmacology, Faculty of Health Sciences, Campus of Soria, University of Valladolid, Soria, Spain.
⁶ Neurobiology Research Group, Faculty of Medicine, University of Valladolid, Valladolid, Spain.
⁷ CEIm, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.

Abstract

Introduction: Non-adherence to antidepressants is associated with worse disease outcomes (morbidity and mortality) and correlates with higher healthcare resource utilization and costs. Methods: A population-based registry study was conducted to assess non-adherence and to analyze the economic burden of treatment and from non-adherence to antidepressants in 2021. Non-adherence was measured by the Medication Possession Ratio and those below 80% were classified as non-adherent. Results: In 2021, 246,718 patients (10.60% [95% CI: 10.48-10.72]) received antidepressants at a cost of €29 million. The median antidepressant cost per patient/year was €70.08€, ranging from €7.58 for amitriptyline to €396.66 for agomelatine. Out-of-pocket costs represented 6.09% of total expenditures, with a median copayment of €2.78 per patient. The 19.87% [95% CI 19.52-20.22)] of patients were non-adherent to antidepressants, costing €3.9 million (13.30% of total antidepressant costs). Non-adherence rates exceeded 20% for the tricyclic antidepressants, fluoxetine (23.53%), fluvoxamine (22.42%), and vortioxetine (20.58%). Venlafaxine (14.64%) and citalopram (14.88%) had the lowest non-adherence rates, of less than 15%. The median cost of non-adherent medications per patient/year was €18.96 and ranged from €2.50 (amitriptyline) to €133.42 (agomelatine). Conclusion: Reducing non-adherence to antidepressants is critical to improving clinical and economic outcomes. The implementation of interventions and standardized measures, including early detection indicators, is urgently needed. Antidepressants differ with regard to non-adherence and their cost, and this should be considered when prescribing this medication. The Medication Possession Ratio could be used by the healthcare provider and clinician to identify non-adherent patients for monitoring, and to take necessary corrective actions.

Keywords: antidepressant; anxiety; depression; drug utilization; medication adherence; mental disorders; psychotropic drugs.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This research was funded by Gerencia Regional de Salud de Castilla y León, Spain, grant number GRS 2589/B/22.