Objective: To examine trends in the prevalence, utilization, and costs of psychotropic medication in Ontario’s elderly between 1993 and 2002.
Design: Descriptive, longitudinal.
Materials and Methods: The Ontario Drug Benefits database was analyzed for descriptive information on all prescriptions and costs of medications used by those 65 and over in Ontario between 1993 and 2002. Medications were codified by class of drug.
Results: While there was little change over time in the proportion of elderly on psychotropic medication (21% in 1993 to 23% in 2002), the total number of yearly psychotropic prescriptions increased from 3.0 million to 5.7 million. Benzodiazepines were the most frequently prescribed medication throughout the time span, although their prevalence declined from 16% to 14%. Prevalence of antidepressants increased from 5% to 9%. There was little change over the time period in the number of prescriptions of antipsychotics or mood stabilizers. Cholinesterase inhibitors, which did not exist in 1993, were used by 2% of the elderly in 2002. From 1993 to 2002, the total annual cost of psychotropic prescriptions increased from $40.4 million to $149.4 million, and although cholinesterase inhibitors make up only 6% of all psychotropic prescriptions, they account for 25% of the cost.
Conclusion: While overall prevalence of psychotropic use in the population has remained relatively stable since 1993, with the aging of the population, the number of prescriptions has increased nearly two-fold, and the costs have increased more than 3.5-fold. Over the last nine years, newer antidepressants with purportedly better tolerability and safety have become available for the treatment of major depression, and for the first time, cognitive enhancing medications have entered the market for people with dementia. However, these novel agents have a dramatic impact on overall cost. Cost-effectiveness studies are urgently needed, as the current cost of the newer medications will be prohibitive should guidelines for widespread use be implemented.
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