gms | German Medical Science

28. Jahrestagung der Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie (GAA)

Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie

11.11. - 12.11.2021, digital

Changes in drug prescriptions during the SARS-CoV-2 pandemic

Meeting Abstract

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Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie e.V. (GAA). 28. Jahrestagung der Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie. sine loco [digital], 11.-12.11.2021. Düsseldorf: German Medical Science GMS Publishing House; 2021. Doc21gaa14

doi: 10.3205/21gaa14, urn:nbn:de:0183-21gaa149

Veröffentlicht: 10. November 2021

© 2021 Schüssel et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe



Background: The Covid-19 pandemic declared by WHO in March 2020 has had a huge impact on the health care sector. Apart from the treatment of, and vaccination against, the disease, other areas of drug use have also been affected, related to the many changes in behaviour that were brought on by the fight against the pandemic. We attempt to describe effects on drug utilisation in Germany and to provide plausible narratives for some of the observed effects. As a secondary area of interest, we looked at some specific drugs that have been touted, at various times, as being protective against SARS-CoV2 infections, viz., vitamin D, hydroxychloroquine, and ivermectin.

Materials and Methods: We provide a descriptive overview of changes within the German statutory health care system (GKV), using GKV-wide GAmSI prescription DDD data in the ambulatory sector from January 2019 to June 2021. In order to exclude seasonal effects, we use values indexed by 2019, i.e., we divide the DDD volume in the various months of 2020 and 2021 by the volume of the corresponding month in 2019. We complement this data set with data specific to a large subgroup of German statutory health care funds (AOK), which allows us to describe monthly changes in the number of incident cases for several widespread chronic diseases, defined as the number of new users of typical drugs from a therapeutic area who had received no such treatment during the twelve preceding months. Calculations were performed using R 4.1.1.

Results: With the initial lockdown in March 2020 impending, we notice substantial stock-piling of drugs, particularly in areas of “plannable” medication, i.e., for treatment of chronic diseases such as diabetes or cardiovascular diseases. This stock-piling is followed by a short period of reduced prescriptions in April and May 2020. Afterwards, prescribing returns to the pre-Covid level. For drugs used in the treatment of acute infectious diseases such as systemic antibiotics or medication for common cold, we do not observe any such stock-piling. Instead, the level of prescribing in 2020 was well below the level of 2019, with especially low levels during phases of lockdown or reduced social contacts. For some drugs, increased prescription rates were observed: pneumococcus vaccines with a more than six-fold increase at the start of the pandemic, and drugs used for treatment of cystic fibrosis with a substantial increase starting in August 2020.

The volume of vitamin D prescribing was increased for most of the times of the pandemic. For hydroxychloroquine, we did not observe an increased use apart from stock-piling in March 2020. Ivermectin prescriptions, which are generally on a low level (0.018 DDD per 1000 insurees per day in 2020), were reduced starting in August 2020.

There were no noticeable differences in the effects according to the sex of patients. For children, decreased prescribing during the lock-down phases was more pronounced than in the general population. Decreases have not only occurred for the initial lockdown, but can also be observed between October 2020 and May 2021. The effect is most pronounced for drugs often used in treatment of acute infectious diseases like antibiotics, antiinflammatory drugs, medication for common cold, diarrhea or vomiting. Vitamin D, which is often prescribed to children, shows an increased level of prescribing in the pandemic period.

For drugs used in several chronic conditions, we observed a noticeable decline in the number of new users during the lockdown phase in April 2020, e.g., for antidiabetics, antihypertensives, and lipid-lowering agents. In subsequent months, the number of incident cases quickly returned to the same level as in the years before. The number of newly-started therapies against breast cancer and cancer of the prostate was slightly reduced during the first lockdown phase in April 2020, approaching pre-pandemic levels near the end of 2020.

Conclusion: The initial stock-piling widely seen in the prescription market in March 2020 was compensated for by fewer prescriptions in the following months. Thus, initial concern that the pandemic would be accompanied by increased drug prescriptions did not come to pass. The driving factor may have been a fear of drug shortages (as has happened with other goods), or it may have been a joint attempt by both patients and prescribing physicians to reduce the number of visits for refills, thus diminishing contacts in crowded waiting-rooms with ensuing risk of infection. In either case, these were rationally motivated moves (even if fear of shortages turned out to be generally unfounded). The subsequent return of volumes to pre-Covid levels for most therapeutic areas shows that established needs for drug treatment have been largely satisfied.

Consistent with this, there was no stock-piling for medicines with unforeseeable use, e.g., antibiotics and drugs for treating acute respiratory tract diseases. The decline of antibiotic prescribing during lockdown phases may be explained by lower cases of infections in times of limited contacts between people. Also, sufferers of mild infections may have avoided seeking treatment in order to reduce the risk of contracting SARS-Cov2. Outside of lockdown phases, however, cases rebounded, especially for respiratory infections among children.

Similarly, the temporary reduction of incident cases may be a reflection of people’s unwillingness to see a physician during lockdown, or even of physicians discouraging non-acute patients from consultation. On the other hand, the development of incident oncological treatment indicates that serious new conditions were, in the majority of cases, properly treated.

Increased use of vitamin D is most clearly seen for children, where it is reimbursable. For adults, this effect was not observed. (Any possible increase in OTC sales could not be taken into account, because they are not reimbursed and thus not included in the health insurance data sets.) For the other drugs (hydroxychloroquine and ivermectin), the hype about these drugs purportedly protective against SARS-Cov2 infections has not had any noticeable impact on their prescribing frequencies.


Enners S, Gradl G, Kieble M, Böhm M, Laufs U, Schulz M. Utilization of drugs with reports on potential efficacy or harm on COVID-19 before, during, and after the first pandemic wave. Pharmacoepidemiol Drug Saf. 2021 Nov;30(11):1493-503. DOI: 10.1002/pds.5324 Externer Link
EUnetHTA Rolling Collaborative Review (RCR20) Authoring Team. High-Dose Vitamin D for the treatment of COVID-19. Diemen (The Netherlands): EUnetHTA; 2021.