Consumption of antidepressants and economic austerity in Brazil

ABSTRACT

Objective

To describe consumption of antidepressants in Brazil through dispensing data from pharmacy retail outlets, in between 2011 and 2017, and explore the relationship between consumption patterns and changing economic context during this period.

Methods

A time-series analysis of dispensing data from pharmacy retail outlets was carried out considering 10 commonly used antidepressants. DDDs/1000 inhabitants/year for each drug were calculated for each quarter. Ttime-series graphs were constructed to analyze the volumes of drugs purchasedRelationship between economic context and consumption was assessed using the following indicators: annual percent change in Gross Domestic Product (GDP), public debt (% of GDP), and annual net savings (in billions of Brazilian reais – BRL).

Results

Overall consumption of antidepressants increased over the study period despite a sharp fall of −3.55% in annual percent change in GDP, negative net annual savings of −53.568 BRL, and an increase in public debt exceeding 32% of the GDP during the economic crisis of 2015.

Conclusion

Consumption of antidepressants from pharmacy retail outlets increased even within a context of economic crisis, which may be a reflection of the disease burden in Brazil. Health budget cuts due to the economic crisis may be directing users to out-of-pocket expenses, deepening social inequalities.

KEYWORDS:

• Drug utilization studies
• antidepressants
• time-series
• consumption studies

Acknowledgments

Data used in this research were formally required and made available by Brazilian Health Regulatory Agency (Anvisa). Thus, the authors would like to thank this institution for providing data from the National Controlled Products Management System (SNGPC). We also thank the Brazilian Council of Scientific and Technological Development (CNPq).

Author contributions

L Mattos, C Osorio-de-Castro, C Santos-Pinto and B Wettermark were involved in study design, data collection, interpretation and discussion of results, appropriate presentation of results and revising the manuscript. C Andrade contributed to study design, data collection and the processing and statistical handling of the data to generate the results and revising the manuscript. All authors read the final version of the manuscript critically and approved the final version to be published.

Declaration of interest

C Osorio-de-Castro discloses support from Brazilian Research and Development Council (CNPq) grant number 304,975/2016-8. She also declares the following: Co-Chair, Brazilian Regional Interest Group, ISPE; Council Member, Brazilian Interdisciplinary AIDS Association (ABIA); Council Member, National Justice Council Rio de Janeiro Health Committee; Council Member, Brazilian Cancer Institute (INCA); Member of the Open Science Committee of the Sergio Arouca National School of Public Health (ENSP/Fiocruz); Associate Editor, Reports in Public Health; and Associate Editor, Science and Collective Health. All committee or council memberships are unpaid. B Wettermark declares the following: Board member of European Drug Utilization Research group; Board member of Swedish Society for Epidemiology and Scientific Advisor of Swedish regulatory agency. C Andrade declares the following: Adjunct Coordinator, Research Ethics Committee of Sergio Arouca National School of Public Health (ENSP/Fiocruz). Committee membership is unpaid. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Notes

1. Commercial annual average exchange rate BRL vs US dollar: 2011: 1,6750; 2012: 1,9546; 2013: 2,1576; 2014: 2,3534; 2015: 3,3315; 2016: 3,4901; 2017: 3,1920 (Source: IPEA data).

Additional information

Funding

This project was funded by the Brazilian Research and Development Council (CNPq), Project no. 305508/2020-2, on behalf of Claudia Garcia Osorio Serpa de Castro. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.