title: Changes over time in prescription practices of pain medications in Switzerland between 2006 and 2013: an analysis of insurance claims.
abstract: In Europe, scant information is available about prescription practices for pain medications. The aim of this research was to assess changes in prescription rates of non-opioid, weak opioid, and strong opioid medications between 2006 and 2013 in the Swiss population.
  
  
  
  Using insurance claims data covering one-sixth of the Swiss population, we analyzed the numbers of reimbursed pain medications, the number of reimbursements per persons, and the cumulative dose in milligrams. For opioids, the morphine equivalent dose and treatment days were calculated. Data were extrapolated to the dose per day per 100'000 population stratified by age, gender, and canton.
  
  
  
  In total, 4'746'942 paracetamol, 2'156'620 NSAIDs or Coxibs, 931'129 metamizole, 1'322'272 weak opioid, and 807'835 strong opioid claims were analyzed. Between 2006 and 2013, the increase in claims per 100'000 persons was 32% for paracetamol, 242% for metamizole, 107% for NSAIDS, 86% for Coxibs, 13% for weak opioids, and 121% for strong opioids. For strong opioids the total MED in mg /100'000 increased by 117%, the treatment days /100'000 by 101%. For strong opioids, fentanyl was most frequently used (increase between 2006 and 2013 by 91% for MED/100'000 persons and 94% treatment days / 100'000) followed by buprenorphine and oxycodone. The highest proportional increase in MED / 100'000 was observed for methadone (+1414%) and oxycodone (+313%). Marked geographical variation was detected in the use of metamizole, paracetamole, and strong opioids in different cantons.
  
  
  
  The analysis of insurance claims data provides evidence that the prescription rates for pain medications increased in Switzerland within the last ten years, in particular for metamizole and strong opioids. Furthermore, the prescription rates for metamizole, paracetamol, and strong opioids varied substantially between different cantons in Switzerland.
authors.affiliation: Horten-Centre for patient oriented research and knowledge transfer, University of Zurich, CH-8032, Zurich, Switzerland. Maria.Wertli@insel.ch.|Department of General Internal Medicine, Bern University Hospital, University of Bern, CH-3010, Bern, Switzerland. Maria.Wertli@insel.ch.
authors.forename: Maria M
authors.identifier: 0000-0001-6347-0198
authors.initials: MM
authors.lastname: Wertli
authors.affiliation: Department of Health Sciences, Helsana, Zürichstrasse 130, CH-8600, Dübendorf, Switzerland.
authors.forename: Oliver
authors.initials: O
authors.lastname: Reich
authors.affiliation: Department of Health Sciences, Helsana, Zürichstrasse 130, CH-8600, Dübendorf, Switzerland.
authors.forename: Andri
authors.initials: A
authors.lastname: Signorell
authors.affiliation: Horten-Centre for patient oriented research and knowledge transfer, University of Zurich, CH-8032, Zurich, Switzerland.
authors.forename: Jakob M
authors.initials: JM
authors.lastname: Burgstaller
authors.affiliation: Horten-Centre for patient oriented research and knowledge transfer, University of Zurich, CH-8032, Zurich, Switzerland.
authors.forename: Johann
authors.initials: J
authors.lastname: Steurer
authors.affiliation: Horten-Centre for patient oriented research and knowledge transfer, University of Zurich, CH-8032, Zurich, Switzerland.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Held
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage*; D011307:Drug Prescriptions; D005060:Europe; D005260:Female; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy*; D010818:Practice Patterns, Physicians'; D013557:Switzerland
chemical_list: D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal
keywords: Insurance claims data; Metamizole; NSAID; Non-opioids; Opioids; Pain medications; Paracetamol