Past Issues

The Prescription Pattern and Analyses of Antidepressants under the National Health Insurance Policy in Taiwan

C h o n g - Heng Huang, Chi-Ming Chen, Kuang-Yang Hsu, Lihjen C Wang, Shih-Ying Chen, Ching-Fen Lee

Background: In this study, we examined trends associated with various antidepressants
competing in the Taiwanese market, based on data from the National
Health Insurance (NHI) Research Database. Methods: The cases of patients diagnosed
with depression were selected as the subjects of this study. The prescription
and use of antidepressants were analyzed to shed light on the competition in the
market and substitution of these drugs, as infl uenced by the NHI insurance system.
Results: The data indicated that the number of patients diagnosed with clinical
depression was increased twofold and that the associated expenditure on antidepressants
was increased threefold between 1997 and 2004. We also observed the
total incremental use of antidepressants in each category, indicating that thirdgeneration
antidepressants continued to dominate market, and gradually replaced
those of the fi rst-generation antidepressants. The use of second-generation antidepressants
was found to have remained relatively unchanged. Among all levels of
hospital organizations, third-generation antidepressants were found to be preferred.
The medical staff at district hospitals and primary care clinics prescribed
more fi rst-generation antidepressants than those at regional hospitals or medical
centers. Conclusions: The use of third-generation antidepressants has surpassed
that of fi rst- and second-generation. The non-free market drug reimbursement
mechanism governed by NHI had infl uence on prescription patterns of antidepressants
in hospitals. All aspects of competition among antidepressants are in line
with the Porter’s theory of competition.
Key Word antidepressants, National Health Insurance Research Database, drug generation substitution, drug generation competition
Editorial Committe, Taiwanese Journal of Psychiatry
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