A Population-Based Study of the Use of Selective Serotonin Reuptake Inhibitors before and after Introduction of Generic Equivalents

By Bolton, James M.; Dahl, Matthew et al. | Canadian Journal of Psychiatry, April 2012 | Go to article overview

A Population-Based Study of the Use of Selective Serotonin Reuptake Inhibitors before and after Introduction of Generic Equivalents


Bolton, James M., Dahl, Matthew, Sareen, Jitender, Enns, Murray W., Leslie, William D., Collins, David M., Alessi-Severini, Silvia, Canadian Journal of Psychiatry


Objective: Generic drugs are less expensive than their branded equivalents, but receive limited promotion. This study sought to examine how user rates of individual selective serotonin reuptake inhibitors (SSRIs) changed after the introduction of their generic equivalents.

Method: Administrative health and census data were used to examine the rates of use of all 6 SSRIs from 1996 to 2009 in the province of Manitoba (population of 1.2 million). The primary outcome measure was a comparison of the rates of use in the pre- and post-generic periods, using generalized estimating equations. Secondary analyses were stratified by specialty of physician prescriber.

Results: Escalating rates of use of branded SSRIs in the pre-generic period significantly decreased after generic versions became available (all Ps < 0.001). Incident use of sertraline and paroxetine continued to decrease throughout the post-generic period (1.5% and 1.9% quarterly decreasing rates, respectively). During the years when generic sertraline, fluoxetine, and fluvoxamine were available, their use declined while branded paroxetine and citalopram use continued to increase. Use of branded citalopram, sertraline, and paroxetine prescribed by general practitioners (GPs) increased at rates significantly higher than when prescribed by psychiatrists (all Ps < 0.001).

Conclusion: The introduction of cheaper generic alternatives of SSRIs paradoxically resulted in their use diminishing rather than increasing. With the exception of escitalopram, branded SSRIs tended to be preferentially used, compared with available less expensive generic SSRIs. These patterns were more pronounced for prescriptions by GPs.

Objectif : Les médicaments génériques sont moins coûteux que ceux des marques équivalentes, mais ils font l'objet d'une publicité limitée. Cette étude cherchait à examiner comment les taux d'utilisation des inhibiteurs spécifiques du recaptage de la sérotonine (ISRS) individuels ont changé après l'introduction des équivalents génériques.

Méthode : Des données administratives de la santé et du recensement ont été utilisées pour examiner les taux d'utilisation de tous les 6 ISRS de 1996 à 2009 dans la province du Manitoba (population de 1,2 million). La première mesure du résultat était une comparaison des taux d'utilisation avant et après les périodes génériques, au moyen d'équations d'estimation généralisées. Les analyses secondaires ont été stratifiées selon la spécialité du médecin prescrivant.

Résultats : Les taux croissants d'utilisation des ISRS de marque dans la période pré-générique ont diminué significativement après que les versions génériques ont été offertes (tous les P < 0,001). L'utilisation incidente de la sertraline et de la paroxetine a continué à décroître durant la période post-générique (taux de décroissance trimestriels de 1,5 % et 1,9 %, respectivement). Durant les années où la sertraline, la fluoxetine, et la fluvoxamine génériques étaient offertes, l'utilisation en a diminué alors que l'utilisation de la paroxetine et du citalopram de marque continuait d'augmenter. L'utilisation du citalopram, de la sertraline, et de la paroxétine de marque prescrits par les omnipraticiens (OP) a augmenté à des taux significativement plus élevés que lorsqu'ils étaient prescrits par des psychiatres (tous les P < 0,001).

Conclusion : L'introduction de substituts des ISRS génériques moins coûteux a paradoxalement entraîné une diminution plutôt qu'une augmentation de l'utilisation des ISRS génériques. À l'exception de l'escitalopram, l'utilisation des ISRS de marque tend à être préférée, comparativement aux ISRS génériques moins coûteux offerts. Ces modèles étaient plus prononcés pour les prescriptions faites par les omnipraticiens.

Key Words: antidepressants, selective serotonin reuptake inhibitors, generic medication, prescription rates, epidemiology

Received June 2011, revised, and accepted September 2011. …

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