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Articles   |    
Diffusion of Antipsychotics in the U.S. and French Markets, 1998–2008
Adeline Gallini, Pharm.D., Ph.D.; Julie M. Donohue, Ph.D.; Haiden A. Huskamp, Ph.D.
Psychiatric Services 2013; doi: 10.1176/appi.ps.004662012
View Author and Article Information

Dr. Gallini is affiliated with the Department of Epidemiology, University of Toulouse, 37 allées Jules Guesde, Toulouse 31000, France (e-mail: adeline.gallini@univ-tlse3.fr). Dr. Donohue is with the Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania. Dr. Huskamp is with the Department of Health Care Policy, Harvard Medical School, Boston.

Copyright © 2013 by the American Psychiatric Association

Abstract

Objective  Second-generation antipsychotics captured most of the U.S. antipsychotic market shortly after their introduction. Little is known about how second-generation antipsychotics have diffused in other countries with different health systems. The study objective was to describe trends in antipsychotic use in the United States and France from 1998 to 2008.

Methods  Pharmaceutical policies in France and the United States are briefly described, followed by descriptive data on quarterly prescriptions for oral antipsychotics dispensed between January 1998 and September 2008. Data are from Xponent for the United States and the GERS database for France. Trends in the use of first- versus second-generation antipsychotics and in ingredient formulations of second-generation antipsychotics used are reported.

Results  Between 1998 and 2008, total antipsychotic use in the United States increased by 78%. Total use in France was consistently higher despite a 9% decrease during the period. By 2008, second-generation antipsychotics represented 86% of the antipsychotics sold in the U.S. market, versus only 40% of the French market. However, average annual growth rates in use of second-generation antipsychotics were similar in the two countries. In France, use of all but one second-generation antipsychotic steadily increased, whereas in the United States trends in the use of newer drugs varied substantially by drug. For example, use of olanzapine decreased after 2003, but use of quetiapine increased.

Conclusions  These results highlight markedly divergent trends in the diffusion of new antipsychotics in France and the United States. Some differences may be explained by differences in health systems; others may reflect physicians’ preferences and norms of practice.

Abstract Teaser
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Figure 1 Trends in antipsychotic use in the United States and France, 1998–2008a

aSources: United States, IMS Xponent, 1996–2008, IMS Health, Inc. France, GERS database 1998–2008. FGA, first-generation antipsychotics; SGA, second-generation antipsychotics

Figure 2 Evolution of first- and second-generation antipsychotic market shares in the United States and France, 1998–2008a

aSources: United States, IMS Xponent, 1996–2008, IMS Health, Inc.; France, GERS database 1998–2008. FGA, first-generation antipsychotics; SGA, second-generation antipsychotics

Figure 3 Use of specific second-generation antipsychotics in France and the United States, 1998–2008a

aSources: United States, IMS Xponent, 1996–2008, IMS Health, Inc.; France, GERS database 1998–2008

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Table 1Pharmaceutical approval, marketing, coverage, and monitoring in the U.S. and French health systems
Table Footer Note

a Agence Nationale de Sécurité du Médicament, formerly known as AFSSaPS (Agence Française de Sécurité Sanitaire des Produits de Santé)

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Table 2Availability and labeled indications of oral second-generation antipsychotics in the United States and in Francea
Table Footer Note

a Only the second-generation antipsychotics approved in at least one of the two countries before September 2008 are presented in this table. Unless otherwise stated, the indication is approved for adults only.

Table Footer Note

b Approved only in United States as treatment for mixed episodes

Table Footer Note

c Indication approved only in listed country

Table Footer Note

d Combination therapy approved only in United States

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