title: Contribution of prolonged-release melatonin and anti-benzodiazepine campaigns to the reduction of benzodiazepine and Z-drugs consumption in nine European countries.
abstract: BACKGROUND
  Benzodiazepines (BZD) and benzodiazepine receptor agonists (zolpidem, zaleplon, zopiclone, altogether Z-drugs) are most commonly prescribed for the treatment of insomnia. However, long-term use of BZD/Z-drugs is associated with major adverse events including, but not limited to, falls and fractures, domestic and traffic accidents, confusion, cognitive impairment, Alzheimer's disease and cancer. The prolonged use of these drugs is thought to be related to severe withdrawal symptoms and potential dependency. The chronic and extensive use of BZD/Z drugs has become a public health issue and has led to multiple campaigns to reduce both prescription and consumption of BZD/Z-drugs. Prolonged-release (PR) melatonin is the first of a new class of melatonin receptor agonist drugs that has demonstrated clinically relevant efficacy on improving quality of sleep and morning alertness, with a good safety profile.
  
  
  OBJECTIVE
  This study aimed to analyze and evaluate the impact of anti-BZD/Z-drugs campaigns and the availability of alternative pharmacotherapy (PR-melatonin) on the consumption of BZD and Z-drugs in several European countries.
  
  
  METHODS
  Annual sales data from nine European countries were extracted from the IMS sales database and analyzed to determine whether trends in use of these treatment options were attributed to campaigns and/or availability and affordability of safer alternatives on the market.
  
  
  RESULTS
  Campaigns aiming to reduce the use of BZD/Z-drugs failed when they were not associated with the availability and market uptake of PR-melatonin. The reimbursement of PR-melatonin supports better penetration rates and a higher reduction in sales for BZD/Z-drugs.
authors.affiliation: Laboratoire de santé publique évaluation des systèmes de soins et santé perçue, University of the Mediterranean, Marseille, France. ecl@creativ-ceutical.com
authors.forename: Emilie
authors.initials: E
authors.lastname: Clay
authors.forename: Bruno
authors.initials: B
authors.lastname: Falissard
authors.forename: Nicholas
authors.initials: N
authors.lastname: Moore
authors.forename: Mondher
authors.initials: M
authors.lastname: Toumi
mesh_terms: D001569:Benzodiazepines / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D016208:Databases, Factual; D003692:Delayed-Action Preparations; D017723:Drug Utilization Review; D005060:Europe; D006293:Health Promotion; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000191:economics / Q000627:therapeutic use; D008389:Marketing of Health Services; D008550:Melatonin / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use; D012051:Reimbursement Mechanisms; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy
chemical_list: D003692:Delayed-Action Preparations; D006993:Hypnotics and Sedatives; D001569:Benzodiazepines; D008550:Melatonin