title: Regional variations of private prescriptions for the non-benzodiazepine hypnotics zolpidem and zopiclone in Germany.
abstract: OBJECTIVE
  Although evidence is lacking, there is general perception that zolpidem and zopiclone ('Z-drugs') are more effective and safer than benzodiazepines leading to an increased prescribing of Z-drugs. In Germany, 85% of the inhabitants are covered by statutory health insurance (SHI), the rest is privately insured. Z-drugs are covered by SHIs but physicians can also provide private prescriptions for SHI insured persons, who then have to pay for these out of pocket. Since private prescriptions are not documented in SHI claims data, physicians might prescribe drugs associated with abuse as private prescriptions. We aim to quantify SHI versus private prescriptions of Z-drugs and analyze regional variations.
  
  
  METHODS
  We studied a sample of 2500 community pharmacies located across Germany from 2006 to 2008. We analyzed the amount of private prescriptions in numbers of packages. Drug utilization was expressed in defined daily doses (DDDs) per 1000 inhabitants per day (DID).
  
  
  RESULTS
  The proportions of private prescriptions ranged between 36.7% and 36.9% per annum for zopiclone, this was significantly higher for zolpidem (49.4-49.6% per annum). There are substantial regional variations for zolpidem (28.8-82.6%) and zopiclone (22.5-68.6%). In all federal states the proportion of zolpidem not reimbursed by SHIs is higher than that of zopiclone (6.3-15.4%). The nation-wide outpatient consumption was 2.5 DID for zolpidem and 2.7 DID for zopiclone with large regional variations.
  
  
  CONCLUSIONS
  In addition to large regional variations, zolpidem is more often prescribed as a private prescription than zopiclone. This might be a signal for a higher abuse potential of zolpidem.
authors.affiliation: Division Health Economics, Centre for Social Policy Research, Health Policy and Outcomes Research, University of Bremen, Bremen, Germany. hoffmann@zes.uni-bremen.de
authors.forename: Falk
authors.initials: F
authors.lastname: Hoffmann
authors.forename: Markus
authors.initials: M
authors.lastname: Hies
authors.forename: Gerd
authors.initials: G
authors.lastname: Glaeske
mesh_terms: D053961:Azabicyclo Compounds / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000378:metabolism; D016208:Databases, Factual; D011307:Drug Prescriptions; D005858:Germany; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D010045:Outpatients; D010594:Pharmacies; D010879:Piperazines / Q000627:therapeutic use*; D010818:Practice Patterns, Physicians'; D017149:Private Sector; D011725:Pyridines / Q000627:therapeutic use*; D019966:Substance-Related Disorders; D000077334:Zolpidem
chemical_list: D053961:Azabicyclo Compounds; D006993:Hypnotics and Sedatives; D010879:Piperazines; D011725:Pyridines; C515050:zopiclone; D001569:Benzodiazepines; D000077334:Zolpidem