David De Bandt1, Sarah Safsaf1, Bastien Bourrion1,2, Mathilde Francois1,2. 1. Department of Family Medicine, Faculty of Health Sciences, Simone Veil, University of Versailles, Saint-Quentin-en-Yvelines, France. 2. Centre for Research in Epidemiology and Population Health, the French National Institute of Health and Medical Research (INSERM U 1018), University of Versailles, Saint-Quentin-en-Yvelines, University Paris-Sud, Villejuif, France.
Abstract
CONTEXT: Serious adverse events related to the use of domperidone and metoclopramide have been consistently reported in the literature for many years. This led to a restriction of their use in the early 2010s. OBJECTIVE: The main objective was to analyse the evolution of antiemetic prescription rate in French general practise between 2006 and 2016. The secondary objectives were to highlight prescription transfers for metopimazine and to quantify the impact on health expenditures. METHOD: All patients from a representative sample of a national administrative claims database, the French national health insurance database, were included between 2006 and 2016. Trends in annual anti-emetic prescription rates by general practitioners were analysed using logistic regression models adjusted for age, gender and the existence of cancer. The cost of theses changing prescription habits was quantified via Médic'AM, a public drug expenditure database. RESULTS: Around 669 020 individuals were included with a mean 8-year follow-up; 48 634 patients received an anti-emetic at least once between 2006 and 2016. Prescription rates for all antiemetics decreased significantly from 2.1% to 0.4%, especially for metoclopramide from 0.5% to 0.1%, for domperidone from 1.5% to 0.1% and for metopimazine from 0.4% to 0.2%, which is not in favour of prescription transfers. Expenses fell from 30 million euros in 2006 to 10 million in 2016. CONCLUSION: Decreases in anti-emetic prescription rates and public health expenditures preceded the publication of official recommendations to reduce the use of metoclopramide and domperidone, without prescription transfers for metopimazine.
CONTEXT: Serious adverse events related to the use of domperidone and metoclopramide have been consistently reported in the literature for many years. This led to a restriction of their use in the early 2010s. OBJECTIVE: The main objective was to analyse the evolution of antiemetic prescription rate in French general practise between 2006 and 2016. The secondary objectives were to highlight prescription transfers for metopimazine and to quantify the impact on health expenditures. METHOD: All patients from a representative sample of a national administrative claims database, the French national health insurance database, were included between 2006 and 2016. Trends in annual anti-emetic prescription rates by general practitioners were analysed using logistic regression models adjusted for age, gender and the existence of cancer. The cost of theses changing prescription habits was quantified via Médic'AM, a public drug expenditure database. RESULTS: Around 669 020 individuals were included with a mean 8-year follow-up; 48 634 patients received an anti-emetic at least once between 2006 and 2016. Prescription rates for all antiemetics decreased significantly from 2.1% to 0.4%, especially for metoclopramide from 0.5% to 0.1%, for domperidone from 1.5% to 0.1% and for metopimazine from 0.4% to 0.2%, which is not in favour of prescription transfers. Expenses fell from 30 million euros in 2006 to 10 million in 2016. CONCLUSION: Decreases in anti-emetic prescription rates and public health expenditures preceded the publication of official recommendations to reduce the use of metoclopramide and domperidone, without prescription transfers for metopimazine.