title: The association between lifting an administrative restriction on antidepressant dispensing and treatment patterns in Iceland.
abstract: OBJECTIVE
  On March 1st 2009, restrictions on the dispensing of selective serotonin reuptake inhibitors (SSRI) in Iceland were lifted. Incident rates and changes in early discontinuation and switching before and after the change were investigated.
  
  
  METHODS
  New users of antidepressants between March 1st 2006 and March 1st 2010 were selected from the Icelandic Prescriptions Database. The study population was split into one intervention cohort (2009) and three comparison cohorts (2006, 2007, and 2008). Incidence rate ratios (IRR) and odds ratios (OR) were used to compare incidence rates and early discontinuation.
  
  
  RESULTS
  The overall incidence rates of antidepressant use decreased from 33.10 to 28.71 per 1000 persons per year (IRR 0.87; 95% confidence interval (CI), 0.78-0.97) from the 2006 to the 2009 cohort. The incidence rate for SSRIs did not change over the period. Early discontinuation for SSRIs increased from 30.2% in 2006 to 34.1% in 2009 (OR 1.19; 95% CI 1.06-1.33).
  
  
  CONCLUSIONS
  The change in reimbursement does not seem to have affected incidence rates but it may be related to increased early discontinuation, which can lead to increased drug wastage. It might be more clinically rational to initiate patients on smaller supply, allowing for more frequent check-up visits.
authors.affiliation: Faculty of Pharmaceutical Sciences, University of Iceland, Hagi, Hofsvallagata 53, 107 Reykjavik, Iceland.
authors.forename: G
authors.initials: G
authors.lastname: Thengilsdottir
authors.forename: H
authors.initials: H
authors.lastname: Gardarsdottir
authors.forename: A B
authors.initials: AB
authors.lastname: Almarsdottir
authors.forename: C B
authors.initials: CB
authors.lastname: McClure
authors.forename: E R
authors.initials: ER
authors.lastname: Heerdink
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000600:supply & distribution* / Q000627:therapeutic use*; D003863:Depression / Q000188:drug therapy; D005260:Female; D006801:Humans; D007055:Iceland; D007349:Insurance, Health, Reimbursement; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011050:Policy Making; D010818:Practice Patterns, Physicians'; D017367:Selective Serotonin Reuptake Inhibitors / Q000600:supply & distribution* / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents; D017367:Selective Serotonin Reuptake Inhibitors