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General Trends in Prices and Prescription Patterns of Anticonvulsants in Germany between 2000 and 2017: Analysis of National and Cohort-Based Data

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Abstract

Objective

Our aim was to explore trends in price evolution and prescription volumes of anticonvulsants (AEDs, antiepileptic drugs) in Germany between 2000 and 2017.

Method

This study used data from annual reports on mean prescription frequency and prices of defined daily doses (DDD) of AEDs in Germany to analyze nationwide trends. Interrupted time series (ITS) analysis was employed to test for significant effects of several statutory healthcare reforms in Germany on AED price evolution. These data were compared to cohort-based prescription patterns of four German cohort studies from 2003, 2008, 2013, and 2016 that included a total of 1368 patients with focal and generalized epilepsies.

Results

Analysis of national prescription data between 2000 and 2017 showed that mean prices per DDD of third-generation AEDs decreased by 65% and mean prices of second-generation AEDs decreased by 36%, whereas mean prices of first-generation AEDs increased by 133%. Simultaneously, mean prescription frequency of third- generation AEDs increased by 2494%, while there was a substantial decrease in the use of first- (− 55%) and second- (− 16%) generation AEDs. ITS analysis revealed that in particular the introduction of mandatory rebates on drugs in 2003 affected prices of frequently used newer AEDs. These findings are consistent with data from cohort studies of epilepsy patients showing a general decrease of prices for frequently used AEDs in monotherapy by 62% and in combination therapies by 68%. The analysis suggests that overall expenses for AEDs remained stable despite an increase in the prescription of “newer” and “non-enzyme-inducing” AEDs for epilepsy patients.

Conclusion

Between 2000 and 2017, a distinct decline in AED prices can be observed that seems predominately caused by a governmentally obtained price decline of third- and second-generation drugs. These observations seem to be the result of a German statutory cost containment policy applied across all health-care sectors. The increasing use of third-generation AEDs to the disadvantage of “old” and “enzyme-inducing” AEDs reflects the preferences of physicians and patients with epilepsy and follows national treatment guidelines.

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Fig. 1

Based on Schwabe et al. [29]

Fig. 2

Based on Schwabe et al. [29]

Fig. 3

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Data availability statement

National prescription frequency and prices: The data that support the findings of this part of the study have been fully published in the annual ‘Arzneiverordnungs-Reports’ by Ulrich Schwabe, Dieter Pfaffrath, Wolf-Dieter Ludwig, and Jürgen Klauber, and are accessible as digital or printed version of the annual ‘Arzneiverordnungs-Report’, published by Springer Verlag Deutschland GmbH. Data for the cohort studies: The data that support the findings of this part of the study are available from the corresponding author [AS], and anonymized data will be shared by request from any qualified investigator. The data are not publicly available due to restrictions by the local ethics commissions prohibiting the publication of unprocessed data that could compromise research participant privacy.

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Author information

Author notes

  1. Jens-Peter Reese and Adam Strzelczyk contributed equally.

Authors and Affiliations

  1. Epilepsy Center Frankfurt Rhine-Main and Department of Neurology, Center of Neurology and Neurosurgery, Goethe-University Frankfurt, Schleusenweg 2-16 (Haus 95), 60528, Frankfurt am Main, Germany

    Laurent M. Willems, Felix Rosenow & Adam Strzelczyk

  2. LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany

    Laurent M. Willems, Susanne Knake, Felix Rosenow, Jens-Peter Reese & Adam Strzelczyk

  3. Epilepsy Center Erlangen and Department of Neurology, University Hospital Erlangen, Erlangen, Germany

    Hajo M. Hamer

  4. Epilepsy Center Hessen and Department of Neurology, Philipps-University Marburg, Marburg (Lahn), Germany

    Susanne Knake, Felix Rosenow & Adam Strzelczyk

  5. Coordinating Center for Clinical Trials, Philipps-University Marburg, Marburg (Lahn), Germany

    Jens-Peter Reese

Authors
  1. Laurent M. Willems
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Contributions

LMW developed the idea for this study. LMW and AS conceived the paper, collected the data, and performed statistical analysis. LMW, JPR, and AS interpreted the statistical analysis and results. LMW and AS created the charts and figures. All authors wrote the paper, discussed the results, contributed to the final manuscript, and approved the final manuscript for publication.

Corresponding author

Correspondence to Adam Strzelczyk.

Ethics declarations

Study funding

This study was supported by the LOEWE Grant for the “Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany.

Conflict of interest

LM. Willems and J.P. Reese report no conflicts of interest. H.M. Hamer has served on the scientific advisory board of Cerbomed, Desitin, Eisai, GW, Novartis, and UCB Pharma. He served on the speakers’ bureau of or received unrestricted grants from Amgen, Ad-Tech, Bial, Bracco, Cyberonics, Desitin, Eisai, Hexal, Nihon Kohden, Novartis, Pfizer, and UCB Pharma. S. Knake reports honoraria for speaking engagements from Desitin and UCB as well as educational grants from AD Tech, Desitin Arzneimittel, Eisai, GW, Medtronic, Novartis, Siemens and UCB. F. Rosenow reports personal fees from Eisai, grants and personal fees from UCB, grants and personal fees from Desitin Pharma, personal fees and others from Novartis, personal fees from Medronic, personal fees from Cerbomed, personal fees from ViroPharma and Shire, grants from the European Union, and grants from the Deutsche Forschungsgemeinschaft. A. Strzelczyk reports personal fees and grants from Desitin Arzneimittel, Eisai, GW Pharma, LivaNova, Medtronic, Sage Therapeutics, UCB Pharma, and Zogenix. All authors confirm that they have read the Journal’s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.

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Willems, L.M., Hamer, H.M., Knake, S. et al. General Trends in Prices and Prescription Patterns of Anticonvulsants in Germany between 2000 and 2017: Analysis of National and Cohort-Based Data. Appl Health Econ Health Policy 17, 707–722 (2019). https://doi.org/10.1007/s40258-019-00487-2

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