title: Treatment patterns and costs in patients with generalised anxiety disorder: one-year retrospective analysis of data from national registers in Sweden.
abstract: OBJECTIVE
  To investigate medication use, direct healthcare costs and comorbidities in patients with generalised anxiety disorder (GAD) within specialised care in Sweden 2006-2007.
  
  
  METHODS
  A retrospective study was conducted using data from the National Patient Register and the Swedish Prescribed Drug Register. All patients with a primary GAD (ICD-10) diagnosis in 2006 were followed for 12 months to study medication use and health care consumption. Resource use was evaluated from the number of hospitalisation episodes, number of visits to outpatient care and medication dispensed. Costs were calculated by multiplying the number of visits and hospitalisation episodes with the corresponding unit costs. Descriptive statistics were used for all analyses.
  
  
  RESULTS
  Three thousand seven hundred and one patients with a primary GAD diagnosis were included in the study. Thirty-four percent of the patients (n=1246) had at least one secondary comorbid diagnosis. SSRIs/SNRIs were the most commonly dispensed medications, followed by benzodiazepine-anxiolytics, hypnotics and antihistamines. The mean number of treatment days for all medications prescribed and dispensed was highest (1144 days) for elderly women aged 65 years or more (treatment days per patient could exceed 365 days due to multiple concomitant medication use). Elderly patients were frequently prescribed benzodiazepine-anxiolytics (n=92/117 men [79%]; n=238/284 women [84%]) and hypnotics (n=70 men [60%]; n=178 women [63%]) compared to the overall study population (n=612/1303 men [47%] and n=935/2398 women [39%], respectively). GAD-related direct costs accounted for 96% of all direct costs. Mean number of hospitalisation days and corresponding costs were high (19 days; SEK 92,156; n=358 [9.7%]) in relation to medication (SEK 5520; n=3352 [91%]) and outpatient costs (SEK 7698; n=3461 [94%]).
  
  
  CONCLUSIONS
  The high rate of polypharmacy, significant psychiatric comorbidity and widespread use of benzodiazepine-anxiolytics and medications not indicated for GAD suggest that the disease burden is high. Total direct costs associated with the disease were high but still likely to be underestimated.
authors.affiliation: Pfizer AB, Vetenskapsvägen 10, 191 90 Sollentuna, Sweden. rebecka.sandelin@pfizer.com
authors.forename: R
authors.initials: R
authors.lastname: Sandelin
authors.forename: J
authors.initials: J
authors.lastname: Kowalski
authors.forename: E
authors.initials: E
authors.lastname: Ahnemark
authors.forename: C
authors.initials: C
authors.lastname: Allgulander
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014151:Anti-Anxiety Agents / Q000191:economics / Q000627:therapeutic use*; D001008:Anxiety Disorders / Q000188:drug therapy* / Q000191:economics; D005260:Female; D017048:Health Care Costs; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019338:Polypharmacy; D012042:Registries; D012189:Retrospective Studies; D013548:Sweden; D016896:Treatment Outcome
chemical_list: D014151:Anti-Anxiety Agents