Hostname: page-component-cd9895bd7-q99xh Total loading time: 0 Render date: 2024-12-25T15:20:26.934Z Has data issue: false hasContentIssue false
  • English
  • Français

Prescribing trends in cognition enhancing drugs in Australia

Published online by Cambridge University Press:  30 July 2010

Samantha A. Hollingworth  and
Gerard J. Byrne
Samantha A. Hollingworth*
Affiliation:
School of Population Health, The University of Queensland, Brisbane, Australia
Gerard J. Byrne
Affiliation:
Discipline of Psychiatry, School of Medicine, The University of Queensland, and Older Persons' Mental Health Service, Royal Brisbane & Women's Hospital, Brisbane, Australia
*
Correspondence should be addressed to: Dr Samantha A Hollingworth, The University of Queensland, School of Population Health, Herston Road, Herston QLD 4006, Australia. Phone: +61 71 3365 5516; Fax: +61 7 3365 5442. Email: [email protected].
Get access

Abstract

Background: This study sought to examine the trends in the prescribing of subsidized and unsubsidized cognition enhancing drugs (CEDs) in Australia over five years from 2002 to 2007. Subsidized cholinesterase inhibitor medication could be prescribed to people with mild to moderate Alzheimer's disease (AD) once a specialist physician had confirmed this diagnosis. Memantine was available for use in moderately severe AD but not subsidized.

Methods: We analyzed the Medicare Australia and Drug Utilisation Sub-Committee databases for CED prescription data, 2002–2007, by gender, age and prescriber class. Aggregated prescription data for each medication were converted to defined daily doses (DDD) per 1000 persons per day using national census data.

Results: There were 1,583,667 CED prescriptions dispensed during the study period. CED use increased 58% from 0.91 to 1.56 DDD/1000 persons/day between 2002 and 2007. Peak use was in those aged 85–89 years. Age-adjusted utilization was slightly higher in females than males. Donepezil was the most widely used CED (66%), followed by galantamine (27%) then memantine (4%). General practitioners prescribed the majority of CEDs. Geriatricians exhibited a greater preference for galantamine than other prescribers. CED dispensing peaked towards the end of each calendar year, reflecting stockpiling by patients under the influence of a federal safety net subsidy.

Conclusions: Despite subsidized access to CEDs in Australia, only a minority of people with AD was prescribed these drugs during the period of the study. It is likely that the combination of complex prescribing rules and negative perceptions about efficacy or cost-effectiveness might have contributed to these findings.

Keywords

dementiacholinesterase inhibitorsdonepezilgalantaminerivastigminememantinePharmaceutical Benefits SchemeprescribingAlzheimer's disease
Type
Research Article
Information
International Psychogeriatrics , Volume 23 , Issue 2 , March 2011 , pp. 238 - 245
Copyright
Copyright © International Psychogeriatric Association 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Australian Bureau of Statistics (2007). Population by Age and Sex, Australian States and Territories. Cat. No. 3201.0. Canberra: Australian Bureau of Statistics.Google Scholar
Australian Government Department of Health and Ageing (2006). Pharmaceutical Benefits Schedule. Canberra: Department of Health and Ageing.Google Scholar
Australian Government Department of Health and Ageing (2008). Australian Statistics on Medicines, 2006. Canberra: Department of Health and Ageing.Google Scholar
Australian Institute of Health and Welfare (2007). Dementia in Australia: National Data Analysis and Development. AIHW cat. no. AGE 53. Canberra: AIHW.Google Scholar
Bartus, R. T., DeanR. L., III R. L., III, Beer, B. and Lippa, A. S. (1982). The cholinergic hypothesis of geriatric memory dysfunction. Science, 217, 408–414.CrossRefGoogle ScholarPubMed
Birks, J. (2006). Cholinesterase inhibitors for Alzheimer's disease. Cochrane Database of Systematic Reviews, CD005593.CrossRefGoogle Scholar
Brodaty, H. and Gresham, M. (1989). Effect of a training programme to reduce stress in carers of patients with dementia. BMJ, 299, 1375–1379.CrossRefGoogle ScholarPubMed
Brodaty, H., Sachdev, P. and Anderson, T. M. (2005). Dementia: new projections and time for an updated response. Australian and New Zealand Journal of Psychiatry, 39, 955–958.CrossRefGoogle ScholarPubMed
Commonwealth of Australia (2010). Australia to 2050: Future Challenges. Canberra: Commonwealth of Australia. Available at http://treasury.gov.au/contentitem.asp?NavId=035&ContentID=1710.Google Scholar
Courtney, C. et al. (2004). Long-term donepezil treatment in 565 patients with Alzheimer's disease (AD2000): randomised double-blind trial. Lancet, 363, 2105–2115.Google ScholarPubMed
Herrmann, N. et al. (2007). A population-based study of cholinesterase inhibitor use for dementia. Journal of the American Geriatrics Society, 55, 1517–1523.CrossRefGoogle ScholarPubMed
Howard, R. J. et al. (2007). Donepezil for the treatment of agitation in Alzheimer's disease. New England Journal of Medicine, 357, 1382–1392.CrossRefGoogle ScholarPubMed
Jorm, A. F., Dear, K. B. and Burgess, N. M. (2005). Projections of future numbers of dementia cases in Australia with and without prevention. Australian and New Zealand Journal of Psychiatry, 39, 959–963.CrossRefGoogle ScholarPubMed
Loveman, E. et al. (2006). The clinical and cost-effectiveness of donepezil, rivastigmine, galantamine and memantine for Alzheimer's disease. Health Technology Assessment, 10, iii–iv, ix–xi, 1–160.CrossRefGoogle ScholarPubMed
Lyketsos, C. G., Steinberg, M., Tschanz, J. T., Norton, M. C., Steffens, D. C. and Breitner, J. C. (2000). Mental and behavioral disturbances in dementia: findings from the Cache County Study on Memory in Aging. American Journal of Psychiatry, 157, 708–714.CrossRefGoogle Scholar
Mamdani, M., Rapoport, M., Shulman, K. I., Herrmann, N. and Rochon, P. A. (2005). Mental health-related drug utilization among older adults: prevalence, trends, and costs. American Journal of Geriatric Psychiatry, 13, 892–900.CrossRefGoogle ScholarPubMed
Oude Voshaar, R. C., Burns, A. and Olde Rikkert, M. G. (2006). Alarming arbitrariness in EU prescription and reimbursement criteria for anti-dementia drugs. International Journal of Geriatric Psychiatry, 21, 29–31.CrossRefGoogle ScholarPubMed
Pariente, A., Helmer, C., Merliere, Y., Moore, N., Fourrier-Reglat, A. and Dartigues, J. F. (2008). Prevalence of cholinesterase inhibitors in subjects with dementia in Europe. Pharmacoepidemiology and Drug Safety, 17, 655–660.CrossRefGoogle ScholarPubMed
Park-Wyllie, L. Y., Mamdani, M. M., Li, P., Gill, S. S., Laupacis, A. and Juurlink, D. N. (2009). Cholinesterase inhibitors and hospitalization for bradycardia: a population-based study. Public Library of Science (PLoS) Medicine, 6, e1000157.Google ScholarPubMed
Robinson, M., Rowett, D., Leverton, A. and Mabbott, V. (2009). Changes in utilisation of anticholinergic drugs after initiation of cholinesterase inhibitors. Pharmacoepidemiology and Drug Safety, 18, 659–664.CrossRefGoogle ScholarPubMed
Rodda, J., Morgan, S. and Walker, Z. (2009). Are cholinesterase inhibitors effective in the management of the behavioral and psychological symptoms of dementia in Alzheimer's disease? A systematic review of randomized, placebo-controlled trials of donepezil, rivastigmine and galantamine. International Psychogeriatrics, 21, 813–824.Google Scholar
Smith, K. et al. (2008). High prevalence of dementia and cognitive impairment in indigenous Australians. Neurology, 71, 1470–1473.CrossRefGoogle ScholarPubMed
Takeda, A. et al. (2006). A systematic review of the clinical effectiveness of donepezil, rivastigmine and galantamine on cognition, quality of life and adverse events in Alzheimer's disease. International Journal of Geriatric Psychiatry, 21, 17–28.CrossRefGoogle ScholarPubMed
Wilcock, G. K., Ballard, C. G., Cooper, J. A. and Loft, H. (2008). Memantine for agitation/aggression and psychosis in moderately severe to severe Alzheimer's disease: a pooled analysis of 3 studies. Journal of Clinical Psychiatry, 69, 341–348.CrossRefGoogle ScholarPubMed
Winblad, B., Jones, R. W., Wirth, Y., Stoffler, A. and Mobius, H. J. (2007). Memantine in moderate to severe Alzheimer's disease: a meta-analysis of randomized clinical trials. Dementia and Geriatric Cognitive Disorders, 24, 20–27.CrossRefGoogle Scholar
World Health Organization (2008). ATC/DDD Index. Oslo: WHO Collaborating Centre for Drug Statistics Methodology. Available at http://www.whocc.no/atcddd/.Google Scholar