IMPACT OF THE FRENCH 2011 POLICY DECISION ON DRUG PRESCRIBING IN DEMENTIA

Purpose: In 2011, the French National Authority for Health decided to downgrade the medical service provided by cholinesterase inhibitors and memantine. The purpose of this study was to assess the impact of this policy decision on drug prescribing patterns for people with dementia.

Method(s): A longitudinal study using data from the French national-health insurance database was performed over a 9-year period. The study population included patients over 65 years old, without exclusion criteria. Rates of drugs prescribing were calculated for each year and the policy’s impact was tested using adjusted segmented regression analysis.

Result(s): During the 2006 – 2014 period, 119,731 individuals were followed. Overall, the annual rates of drug prescribing increased between 2006 and 2011 (from 2.23% (95%CI: 2.13-2.34%) to 2.64% (95%CI: 2.54-2.75%), p < 0.0001) and decreased from 2012 to 2014 (from 2.36% (95%CI: 2.26-2.46%) to 1.92% (95%CI: 1.84-2.01%), p < 0.0001). Drugs for dementia were prescribed at higher rates for females (p < 0.0001), patients older than 85 (p < 0.0001) and patients suffering from at least one other chronic disease (p < 0.0001). The decrease in drug prescribing after 2012 was significantly greater for females (p = 0.0415), patients aged 65-74 (p < 0.0001) and patients suffering from a least one other chronic disease (p < 0.0001).

Conclusion(s): The policy decision implemented in 2011 had a significant impact on the prescribing patterns of drugs used in the treatment of dementia and mainly affected women, younger patients and patients with multimorbidity. This decrease in prescribing could reduce the cost of dementia without diminishing the quality of care.