Mamdani M M, Parikh S V, Austin P C, Upshur R E
Institute for Clinical Evaluative Sciences, the Center for Addiction and Mental Health, Toronto, Canada.
Am J Psychiatry. 2000 Mar;157(3):360-7. doi: 10.1176/appi.ajp.157.3.360.
The authors assessed changes over time in antidepressant utilization among elderly subjects regarding the prevalence of antidepressant users, shifts in prescription patterns, and related financial implications.
The authors conducted a population-based study of more than 1.4 million Ontario residents aged 65 years or older. Cross-sectional data regarding annual antidepressant utilization were obtained from administrative databases for 1993 to 1997. Time series analysis was used to assess trends over time and to make future projections.
The proportion of antidepressant users increased from 9.3% of the elderly population in 1993 to 11.5% in 1997. Prescriptions for selective serotonin reuptake inhibitors (SSRIs) accounted for 9.6% of antidepressant prescriptions dispensed in the first 30 days of 1993 and 45.1% of those dispensed by the last 30 days of 1997 and were projected to increase to approximately 56% by the end of 2000. Prescriptions for tricyclic antidepressants fell from 79.0% in the first 30 days of 1993 to 43.1% by the last 30 days of 1997 and were projected to decline to approximately 28% by the end of 2000. Annual antidepressant costs (in Canadian dollars) increased by 150%, from $10.8 million in 1993 to $27.0 million in 1997. Population shifts and an increase in the prevalence of antidepressant users accounted for at least 20% of this increase, whereas the prescribing transition from tricyclic antidepressants to SSRIs accounted for at least 61% of the increase.
The introduction of SSRIs has had a substantial financial impact at the drug utilization level. Future research should address the appropriate balancing of the cost of newer agents versus their ostensible advantages.
作者评估了老年受试者中抗抑郁药使用情况随时间的变化，包括抗抑郁药使用者的患病率、处方模式的转变以及相关的财务影响。
作者对安大略省140多万名65岁及以上居民进行了一项基于人群的研究。1993年至1997年的年度抗抑郁药使用横断面数据来自行政数据库。采用时间序列分析来评估随时间的趋势并进行未来预测。
抗抑郁药使用者的比例从1993年老年人口的9.3%增至1997年的11.5%。选择性5-羟色胺再摄取抑制剂（SSRI）的处方在1993年头30天内占抗抑郁药处方的9.6%，到1997年最后30天占45.1%，预计到2000年底将增至约56%。三环类抗抑郁药的处方从1993年头30天的79.0%降至1997年最后30天的43.1%，预计到2000年底将降至约28%。年度抗抑郁药费用（以加元计）增长了150%，从1993年的1080万美元增至1997年的2700万美元。人口变化和抗抑郁药使用者患病率的增加至少占这一增长的20%，而从三环类抗抑郁药向SSRI的处方转变至少占增长的61%。
SSRI的引入在药物使用层面产生了重大财务影响。未来的研究应解决新型药物成本与其表面优势之间的适当平衡问题。
