Tuesday1st UK: SSRI / SNRI Antidepressant Statistical Politics: May 2009

Thursday, 7 May 2009

SSRI / SNRI: Statistic Graphs: 1998 to 2008

UK Department of Health, Prescription Cost Analysis (PCA) Statistics for England, 1998 to 2008 transposed to graph form.

Prescriptions & Annual Increases

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1998 total prescriptions for the SSRI / SNRI drug class were 8,27 Million, in 2008 total prescriptions for just one of the drug class, Citalopram / Cipramil, were over 8.99 Million.

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Data collection reference:
Department of Health; NHS; Prescription Cost Analysis (PCA) - England.
1998 to 2007:
http://www.dh.gov.uk/en/PublicationsAndStatistics/Statistics/StatisticalWorkAreas/StatisticalHealthCare/DH_4086488
2008:
http://www.ic.nhs.uk/webfiles/publications/PCA%202008/PCA%202008.pdf
P–2 Tuesday

Totals, Prescriptions & Increases

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1998 to 2008 the total median increase in SSRI / SNRIs prescriptions was over 1.61 Million.

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Data collection reference:
Department of Health; NHS; Prescription Cost Analysis (PCA) - England.
1998 to 2007:
http://www.dh.gov.uk/en/PublicationsAndStatistics/Statistics/StatisticalWorkAreas/StatisticalHealthCare/DH_4086488
2008:
http://www.ic.nhs.uk/webfiles/publications/PCA%202008/PCA%202008.pdf
P–1 Tuesday

Prescription & Increase Totals

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http://farm4.static.flickr.com/3331/3492055975_b1ef73c293_o.jpg

The obvious 2004 to 2005 marginal trends reversal of Total Annual Prescription Increases correlates with: -

1 The “Report of the CSM Expert Working Group on the Safety of Selective Serotonin Reuptake Inhibitors (SSRIs)” published December 2004
http://www.mhra.gov.uk/home/groups/pl-p/documents/drugsafetymessage/con019472.pdf

2 The "House of Commons, Health Committee’s examination into The Influence of the Pharmaceutical Industry" - initiated June 2004 - report published April 5th 2005
http://www.publications.parliament.uk/pa/cm200405/cmselect/cmhealth/42/42.pdf

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Data collection reference:
Department of Health; NHS; Prescription Cost Analysis (PCA) - England.
1998 to 2007:
http://www.dh.gov.uk/en/PublicationsAndStatistics/Statistics/StatisticalWorkAreas/StatisticalHealthCare/DH_4086488
2008:
http://www.ic.nhs.uk/webfiles/publications/PCA%202008/PCA%202008.pdf
P-3 Tuesday

Prescribing Trend Decreases from 2004

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http://farm4.static.flickr.com/3353/3492063913_e42dddd151_o.jpg

The obvious sharp marginal trend reversal of Venlafaxine Total Prescriptions in 2004 to 2006 correlates with: -

1 The “Report of the CSM Expert Working Group on the Safety of Selective Serotonin Reuptake Inhibitors (SSRIs)” published December 2004; which single out Venlafaxine for its potential for cardiotoxicity and toxicity in overdose.
http://www.mhra.gov.uk/home/groups/pl-p/documents/drugsafetymessage/con019472.pdf

2 “NICE Clinical Guidelines 23: Depression” published December 2004, issued new guidelines for treatment with Venlafaxine; 1.5.2.16 restricting treatment initiation to specialist mental health medical practitioners and in 1.5.2.17 reinforcing that venlafaxine treatment should only be managed under supervision of specialist mental health medical practitioners.
http://www.bpd-mind.fsnet.co.uk/NICE_Depression.pdf

Both 1.5.2.16 and 1.5.2.17 recommendations were surreptitiously deleted from the revised prescribing advice issued 31 May 2006 at which point increasing venlafaxine prescription trends resumed.
http://www.nice.org.uk/nicemedia/pdf/CG23fullguideline.pdf

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Data collection reference:
Department of Health; NHS; Prescription Cost Analysis (PCA) - England.
1998 to 2007:
http://www.dh.gov.uk/en/PublicationsAndStatistics/Statistics/StatisticalWorkAreas/StatisticalHealthCare/DH_4086488
2008:
http://www.ic.nhs.uk/webfiles/publications/PCA%202008/PCA%202008.pdf
11-P-04 Tuesday

Prescribing Trends Shift from Paroxetine 2001

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The marginal trend reversal of Paroxetine Total Prescriptions in 2001 correlates with: -

1 USA – August 2001, Paxil (Paroxetine / Seroxat) GSK class action Lawsuit filed in California Superior Court, LA County, USA.
http://www.onlinelawyersource.com/paxil/class-action.html

2 UK - The Guardian, December 10, 2001 article “Anti-depressant 'addicts' threaten legal Case”, publicises that solicitors Graham Ross of Ross & Co, Wirral, and Mark Harvey of Hugh James Ford Simey, Cardiff (Now Hugh James) who had liaised with American lawyers about Paxil are investigating the possibility of a UK Seroxat class action.
http://www.guardian.co.uk/uk/2001/dec/10/medicalscience.highereducation

The increase in the marginal trend reversal of Paroxetine Total Prescriptions in 2002 correlates with: -

3 UK – The Observer February 3, 2002 article “Hard habit to break”, Mark Harvey, of Hugh James Solicitors, Cardiff; instigates further publicity of the adverse drug reactions (ADRs), side effects and withdrawal problems, connected with the Seroxat --- but common to all drugs in the SSRI / SNRI class.
http://www.guardian.co.uk/Archive/Article/0,4273,4348653,00.html.

4 UK - The Observer, Sunday April 28 2002 “The chemistry of happiness“
http://www.guardian.co.uk/theobserver/2002/apr/28/features.magazine37

5 UK - The November 11th 2002 Parmjit Dhanda Early Day Motion, EDM 238 Seroxat, brought the drug and the SSRI issue to Parliament,
http://edmi.parliament.uk/EDMi/EDMDetails.aspx?EDMID=24050&SESSION=681

The acceleration of the marginal trend reversal of Paroxetine Total Prescriptions in 2003 correlates to: -

6 UK - The ensuing parliamentary questions, media coverage and MIND Seroxat Protest, May 12th 2003 at the MHRA London offices, which made national television news coverage
http://www.mind.org.uk/News+policy+and+campaigns/Press+archive/PRPanoramaSeroxat.htm

The Proxetine prescribing trend continues to decline, all be it at a slower rate.

Significantly, the parliamentary interest and media coverage given to Seroxat and the continuing down trend in Paroxetine prescriptions has had NO impact on the overall marginal trend increases in prescription numbers for the drug class, although ALL are affected by the same ADRs, side effects and withdrawal problems.

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Data collection reference:
Department of Health; NHS; Prescription Cost Analysis (PCA) - England.
1998 to 2007:
http://www.dh.gov.uk/en/PublicationsAndStatistics/Statistics/StatisticalWorkAreas/StatisticalHealthCare/DH_4086488
2008:
http://www.ic.nhs.uk/webfiles/publications/PCA%202008/PCA%202008.pdf
12-P-01p Tuesday

Marginal Trends in Prescribing Change 2004 to 2005

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http://farm4.static.flickr.com/3328/3498274531_2612922799_o.jpg

The obvious marginal trend change in Total Prescriptions 2004 to 2006 correlates with: -

1 The “Report of the CSM Expert Working Group on the Safety of Selective Serotonin Reuptake Inhibitors (SSRIs)” published December 2004 – which found the drug class lacking in safety and efficacy, not notably better than placebo.
http://www.mhra.gov.uk/home/groups/pl-p/documents/drugsafetymessage/con019472.pdf

2 The "House of Commons, Health Committee’s examination into The Influence of the Pharmaceutical Industry" - initiated June 2004 - report published April 5th 2005.
http://www.publications.parliament.uk/pa/cm200405/cmselect/cmhealth/42/42.pdf

3 “NICE Clinical Guidelines 23: Depression” published December 2004, issued new guidelines for treatment of depression with the introduction of the “Watchful waiting”; 1.4.1.2 a 2 week waiting period for patients with mild depression who did not want an intervention; and in 1.4.1.3 the GP to contact if the 2 week follow-up appointment not kept; and the restricting treatment initiation and management of Venlafaxine; 1.5.2.16 and in 1.5.2.17 to specialist mental health medical practitioners.
http://www.bpd-mind.fsnet.co.uk/NICE_Depression.pdf

The marginal trend change in Total Prescriptions 2004, caused the anomaly of a Total Prescription Increase of only 402.6 Thousand; the lowest annual SSRI / SNRI drug class increase in prescriptions in the 10 years available statistics.

Adjusting the median increases in SSRI / SNRIs total prescriptions 1998 to 2008 by removing year 2004 from the equation, increases the median total for 9 of the 10 years from over 1.61 Million per annum to over 1.74 Million.

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Data collection reference:
Department of Health; NHS; Prescription Cost Analysis (PCA) - England.
1998 to 2007:
http://www.dh.gov.uk/en/PublicationsAndStatistics/Statistics/StatisticalWorkAreas/StatisticalHealthCare/DH_4086488
2008:
http://www.ic.nhs.uk/webfiles/publications/PCA%202008/PCA%202008.pdf
9–P-04 Tuesday

Total Drug Net Costs

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1998, total net costs of prescriptions for the SSRI / SNRI drug class were £174,59 Million, these cost peaked in 2004 at £355,44 Million and have subsequently reduced by £159,83 Million to £195,6 Million in 2008.

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Data collection reference:
Department of Health; NHS; Prescription Cost Analysis (PCA) - England.
1998 to 2007:
http://www.dh.gov.uk/en/PublicationsAndStatistics/Statistics/StatisticalWorkAreas/StatisticalHealthCare/DH_4086488
2008:
http://www.ic.nhs.uk/webfiles/publications/PCA%202008/PCA%202008.pdf
4-C Tuesday

Net Drug Costs Variation

Click image to enlarge
http://farm4.static.flickr.com/3596/3510317298_68b3f57c16_o.jpg

The obvious 2004 to 2005 marginal trends reversal of Total Annual Net Costs for SSRI / SNRI Prescriptions correlates with: -

1 The “Report of the CSM Expert Working Group on the Safety of Selective Serotonin Reuptake Inhibitors (SSRIs)” published December 2004
http://www.mhra.gov.uk/home/groups/pl-p/documents/drugsafetymessage/con019472.pdf

2 The "House of Commons, Health Committee’s examination into The Influence of the Pharmaceutical Industry" - initiated June 2004 - report published April 5th 2005
http://www.publications.parliament.uk/pa/cm200405/cmselect/cmhealth/42/42.pdf

****
Data collection reference:
Department of Health; NHS; Prescription Cost Analysis (PCA) - England.
1998 to 2007:
http://www.dh.gov.uk/en/PublicationsAndStatistics/Statistics/StatisticalWorkAreas/StatisticalHealthCare/DH_4086488
2008:
http://www.ic.nhs.uk/webfiles/publications/PCA%202008/PCA%202008.pdf
10–C-04 1 Tuesday

Prescription & Net Drug Cost Totals

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http://farm4.static.flickr.com/3548/3492877450_5e6fe93c12_o.jpg

In the 10 years of available statistics, the 2008 SSRI / SNRI Total Annual Net Costs of £195.6 Million were the lowest since 1998, when Total Net Costs were £174,59 Million.

In 2008 £159,83 Million less cost, brought 16,1 Million more prescriptions than in 1998, when Total Prescription were 8,27 Million.

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Data collection reference:
Department of Health; NHS; Prescription Cost Analysis (PCA) - England.
1998 to 2007:
http://www.dh.gov.uk/en/PublicationsAndStatistics/Statistics/StatisticalWorkAreas/StatisticalHealthCare/DH_4086488
2008:
http://www.ic.nhs.uk/webfiles/publications/PCA%202008/PCA%202008.pdf
7-PC Tuesday