Impact of COVID-19 Restrictions on Nationwide Antipsychotic Use: Results From the Trends in Drug Utilization During COVID-19 Pandemic in Turkey (PANDUTI-TR) Study.

INTRODUCTION

The extraordinary circumstances due to the COVID-19 pandemic and related restrictions altered the management of mental health disorders, including the use of antipsychotics. We aimed to examine the changes in antipsychotic utilization and expenditure in Turkey throughout pandemic-associated restriction periods.

METHODS

Nationwide drug sales and projected prescribing data from 01.03.2018 to 31.12.2022 were obtained from IQVIA Turkey. We assessed average monthly consumption, expenditure, and quarterly prescribing levels across three periods: "before restrictions" (BfR, 01.03.2018-31.03.2020), "during restrictions" (DuR, 01.04.2020-31.03.2022), and "after restrictions" (AfR, 01.04.2022-31.12.2022). Consumption and prescribing levels were measured using "defined daily dose/1000 inhabitants/day" (DID) parameter.

RESULTS

Antipsychotic consumption throughout periods increased from 8.4 ± 0.6 DID in BfR to 9.9 ± 1.6 DID in DuR (p < 0.001), and to 10.1 ± 0.9 DID in AfR (p < 0.001 vs. BfR). Atypical antipsychotics followed the overall trend, whereas typical antipsychotics remained stable from DuR to AfR, deviating from this pattern. Antipsychotic expenditure rose from €16.7 m ± 1.1 m in BfR to €19.0 m ± 2.7 m in DuR (p < 0.001), then shifted to €18.3 m ± 1.9 m in AfR (p > 0.05 vs. BfR and DuR). High-cost antipsychotic use increased after the pandemic onset (p < 0.001) and remained elevated in AfR (p < 0.001). Prescribing for schizophrenia declined from 2.2 ± 0.3 DID in BfR to 1.3 ± 0.2 DID in DuR (p < 0.001), then escalated to 1.8 ± 0.3 DID in AfR (p = 0.015 vs. DuR).

CONCLUSIONS

Our study revealed an upsurge in antipsychotic utilization in Turkey with the start of the pandemic. A range of factors may have contributed, notably the impact of policies facilitating the dispensing of chronic medications without prescription or a tendency towards polypharmacy.