Antiepileptic drug use in seven electronic health record databases in Europe: A methodologic comparison

Abstract

SUMMARYObjective: The annual prevalence of antiepileptic drug (AED) prescribing reported in the literature differs considerably among European countries due to use of different type of data sources, time periods, population distribution, and methodologic differences. This study aimed to measure prevalence of AED prescribing across seven European routine health care databases in Spain, Denmark, The Netherlands, the United Kingdom, and Germany using a standardized methodology and to investigate sources of variation. Methods: Analyses on the annual prevalence of AEDs were stratified by sex, age, and AED. Overall prevalences were standardized to the European 2008 reference population. Results: Prevalence of any AED varied from 88 per 10,000 persons (The Netherlands) to 144 per 10,000 in Spain and Denmark in 2001. In all databases, prevalence increased linearly: from 6% in Denmark to 15% in Spain each year since 2001. This increase could be attributed entirely to an increase in "new," recently marketed AEDs while prevalence of AEDs that have been available since the mid-1990s, hardly changed. AED use increased with age for both female and male patients up to the ages of 80 to 89 years old and tended to be somewhat higher in female than in male patients between the ages of 40 and 70. No differences between databases in the number of AEDs used simultaneously by a patient were found. Significance: We showed that during the study period of 2001-2009, AED prescribing increased in five European Union (EU) countries and that this increase was due entirely to the newer AEDs marketed since the 1990s. Using a standardized methodology, we showed consistent trends across databases and countries over time. Differences in age and sex distribution explained only part of the variation between countries. Therefore, remaining variation in AED use must originate from other differences in national health care systems.

Newer Antiepileptic Drugs in Status Epilepticus: Prescription Trends and Outcomes in Comparison with Traditional Agents

“…A similar trend of increasing prescription of newer compounds has already been described not only in SE, but more generally in patients with epilepsy and in the general population (6)(7)(8)(9)(10)20). In the present study, this increase was mainly due to levetiracetam and lacosamide.…”

Changes in prevalence of psychotropic drug use and alcohol consumption among the elderly in Germany: results of two National Health Interview and Examination Surveys 1997-99 and 2008-11

“…The significant increase in the use of phytoceutical anti-dementia (Ginkgo biloba) in our study was also reported by an American study (1994–1999) [49], while a later conducted American study (1998–2002) [50] found a decrease in the use of Ginkgo biloba. In line with our study too, significant increases in the use of anti-epileptics were described by a Danish [51] and a Canadian [52] study as well as by a study comparing health record data of Spain, Denmark, Netherlands, the UK and Germany [53]. …”

Electronic Health Data for Postmarket Surveillance: A Vision Not Realized

“…A survey of the 20 WP2 peer-reviewed publications shows that the investigators completed much more limited studies that did not evaluate drug-event relationships using different methods across the six databases. For example, the analysis of a possible relationship of anticonvulsant drugs and suicidal behaviors was not published-only a drug exposure study without the health outcome event [16]. Similarly, antidepressant use and hip fracture risk was explored only in a literature review [17].…”