title: Did the removal of the indication of nocturnal enuresis for intranasal desmopressin change prescribing practice?
abstract: OBJECTIVE
  The indication for the treatment of primary nocturnal enuresis was removed from all intranasal preparations of desmopressin in May 2007. Objective of this study was to examine whether and how fast this regulatory decision changed prescribing in affected children.
  
  
  METHODS
  We analyzed claims data of the Gmünder ErsatzKasse (GEK) over the years 2004-2008. All children and adolescents aged 0-18 years who received at least one out-patient diagnosis of urinary incontinence in the corresponding years were included. Our outcome of interest was the proportion of oral desmopressin and its change over time.
  
  
  RESULTS
  A total of 6308 to 7207 children with a mean age of about 8 years were included annually (62-63% were male) and 14 746 packages of desmopressin were analysed (49.9% intranasal; 50.1% oral; 0.01% parenteral preparations). The proportion of patients using desmopressin decreased slightly from 13.9% in 2004 to 12.6% in 2008 ( p for trend = 0.0131). Between January 2004 (39.1%) and December 2006 (41.3%), the proportion of oral forms was nearly constant and doubled after that within a few months to about 80%.
  
  
  CONCLUSIONS
  Immediately after the removal of the indication for intranasal desmopressin, an increased prescribing of tablet forms in affected children was found in Germany.
authors.affiliation: Centre for Social Policy Research, Division Health Economics, 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: Gerd
authors.initials: G
authors.lastname: Glaeske
authors.forename: Christian
authors.initials: C
authors.lastname: Steuber
mesh_terms: D000281:Administration, Intranasal; D000284:Administration, Oral; D000293:Adolescent; D050034:Antidiuretic Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003894:Deamino Arginine Vasopressin / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D005858:Germany; D006801:Humans; D007223:Infant; D008297:Male; D053206:Nocturnal Enuresis / Q000188:drug therapy*; D056687:Off-Label Use; D010818:Practice Patterns, Physicians'; D014549:Urinary Incontinence / Q000188:drug therapy*
chemical_list: D050034:Antidiuretic Agents; D003894:Deamino Arginine Vasopressin