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Reimbursement restriction moderately decreases benzodiazepine use in general practice.

Hoebert, J.M., Souverein, P.C., Mantel, A.K., Leufkens, B.G.M., Dijk, L. van. Reimbursement restriction moderately decreases benzodiazepine use in general practice. Pharmacoepidemiology and Drug Safety: 2011, 20(suppl. 1) S92. Abstract. 27th International Conference on Pharmacoepidemiology and Therapeutic Risk Management, 14-17 Augustus 2011, Chicago.
Background: On January 1st 2009, benzodiazepines were excluded from the Dutch positive reimbursement list when used as anxiolytic, hypnotic or sedative, to limit misuse and for cost savings. Thus far, the (un)intended effects of this reimbursement restriction are unknown. Objectives: To assess the impact of the reimbursement restriction on benzodiazepine use in patients newly diagnosed with anxiety or sleeping disorder. Methods: Diagnoses and prescription data were derived from the electronic medical records based Netherlands Information Network of General Practice (LINH). Patients aged 18 years and older with an incident diagnosis of sleeping disturbance (ICPC code: P06) or anxiety (ICPC code: P74, P01) between January 2008 and December 2009 were identified. Incidence of these diagnoses, benzodiazepine use as well as the initiation of SSRI treatment was compared between 2008 and 2009 (Chi-square test used to compare proportions). Furthermore, persistence of benzodiazepine use was compared between both years using Cox proportional hazard analysis. Results: In the first two to three quarters after the policy change, the incidence of anxiety and sleeping disorders decreased by almost 10% and 12%, respectively. The proportion of patients being prescribed a benzodiazepine following a diagnosis was lower in 2009 compared to 2008 for both anxiety (33.7% vs. 30.0%, p<0.05) and sleeping disorder (67.0% vs. 59.1%, p<0.05) as was the proportion of patients with more than 1 benzodiazepine prescription forboth anxiety (42.6% vs 36.4%, p<0.05) and sleeping disorder (42.6% vs 35.0%, p<0.05). A shift to or an increase in initiation of alternative treatment for anxiety with SSRIs was not found. Patients with sleeping disorder had a lower risk of discontinuation in 2009 compared to 2008 (HR 0.63 95%CI 0.52–0.76), this was not observed for patients with anxiety. Conclusions: The reimbursement restriction has resulted in a moderately positive effect on the use of benzodiazepines, as initiation of benzodiazepine use slightly decreased in patients newly diagnosed with anxiety or sleeping disorder. Besides, no unwanted negative effects, such as shifts to alternative treatment with SSRIs, have been observed. (aut. ref.)
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