title: A cohort study of therapeutic prescriptions after the end of phytotherapy drug reimbursement by French Social Security.
abstract: OBJECTIVE
  The reimbursement of phytotherapy drugs for the treatment of mild anxiety and insomnia ended in March 2006 in France. The aim of this study is to investigate the short-term impact of stopping phytotherapy reimbursement.
  
  
  METHODS
  We monitored the prescriptions of 27,422 patients who received hypnotic and sedative phytotherapy drug treatment at least once in the 12 months preceding the end of reimbursement and made contact with their prescribing physician at least once in the following 12 months. A control cohort was recruited from patients fulfilling the same inclusion criteria in the 24 months before de-reimbursement and their prescriptions in the following 12 months were monitored. The impact of the end of reimbursement is estimated comparing prescription switches in these cohorts.
  
  
  RESULTS
  Before the end of reimbursement, 7684 (28%) patients being prescribed delisted phytotherapy drugs had the relevant drug marketing authorization approval (DMAA) indications. Co-prescriptions of hypnotic and sedative drugs concerned 40% of patients. Of the 4646 DMAA patients exclusively prescribed phytotherapy, 640 (14%) switched to hypnotic or sedative drugs only after the end of reimbursement, 3266 (70%) stopped all treatments and 740 (16%) carried on with a non-reimbursed phytotherapy prescription. When compared to the control cohort, patients exposed to de-reimbursement were more likely to switch to psychotropic drugs (OR = 1.46).
  
  
  CONCLUSIONS
  Ending the reimbursement of common drugs on the basis of insufficient evidence regarding their effectiveness or the low level of severity of their target pathologies should be accompanied by information or advice to prescribing health care actors.
authors.affiliation: Phisquare Institute-Fondation Transplantation, Paris, France.
authors.forename: Lionel
authors.initials: L
authors.lastname: Riou França
authors.forename: Chrystelle
authors.initials: C
authors.lastname: Vidal
authors.forename: Nadia
authors.initials: N
authors.lastname: Bourechak
authors.forename: Philippe Le
authors.initials: PL
authors.lastname: Jeunne
authors.forename: Geoffroy Sainte-Claire
authors.initials: GS
authors.lastname: Deville
authors.forename: Jacques
authors.initials: J
authors.lastname: Massol
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014151:Anti-Anxiety Agents / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D002648:Child; D015331:Cohort Studies; D057225:Data Mining; D016208:Databases, Factual / Q000706:statistics & numerical data*; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D057915:Drug Substitution / Q000706:statistics & numerical data; D017723:Drug Utilization Review / Q000706:statistics & numerical data; D005260:Female; D005602:France; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D066298:In Vitro Techniques; D007349:Insurance, Health, Reimbursement / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D017891:Pharmacoepidemiology; D060735:Pharmacovigilance; D008517:Phytotherapy / Q000706:statistics & numerical data*; D028321:Plant Preparations / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012943:Social Security; D013997:Time Factors; D055815:Young Adult
chemical_list: D014151:Anti-Anxiety Agents; D006993:Hypnotics and Sedatives; D028321:Plant Preparations