gms | German Medical Science

Background: The use of antipsychotics (AP) among children and adolescents in Germany has continued to increase over the decade [1]. However, contemporary data on the use of AP across all age groups are lacking.

Objective: To provide an update on trends in AP use across all age groups in Germany between 2014 and 2023.

Materials and Methods: We analysed anonymised claims data from the German Institute for Drug Use Evaluation (DAPI), containing information on dispensed AP at the expense of Statutory Health (SH) Insurance funds of approximately 87% of the German population.

We selected the ATC code N05A (antipsychotics) except lithium (N05AN01), analysed the quantity of packages dispensed in community pharmacies as packages per 1,000 SH-insured persons per year (PIY) and the defined daily doses per 1,000 SH-insured persons per day (DID).

We stratified the data by age group and type of AP medication (typical vs. atypical) and performed linear regression analyses.

Results: The overall use of AP in DID increased from 2014 to 2023 by 2% (11.44 to 11.63) , and in PIY by 9% (156.49 to 170.20). However, the rise in DID was not statistically significant.

While the typical AP use fell by 29% (4.14 to 2.93 DID), the atypical (second-generation) AP use rose by 19% (7.30 to 8.70 DID), with both changes being statistically significant. The time trends of AP use from 2014 to 2023 in different age groups exhibited differences. The largest increases in AP use were observed in the following age groups: “15 to 19 years” by 32% (1.62 to 2.13 DID), “20 to 24 years” by 28% (3.88 to 4.95 DID), “60 to 64 years” by 18% (15.83 to 18.70 DID), “65 to 69 years” by 28% (12.49 to 16.02 DID), and “70 to 74 years” by 19% (11.43 to 13.57 DID) (Figure 1 [Fig. 1]).

The largest decrease in AP use was in the age group “30 to 34 years” by 21 % (10.60 to 8.38 DID).

The trend analysis for AP use by active ingredients with highest consumption in 2023 showed an increase in quetiapine by 19% (2.07 to 2.46 DID), olanzapine by 24% (1.58 to 1.95 DID), and aripiprazole by 97% (0.62 to 1.22 DID). In contrast, risperidone use slightly decreased by 2% (1.41 to 1.38 DID).

The high usage of AP among the older adults was notable, especially in those aged 90 and above (Figure 1 [Fig. 1]). While PIY increased steadily with advancing age, the DID peaked in the age group of 55 to 59 years, followed by another notable increase in the age groups over 80 years, reaching a maximum in those aged over 90 years.

Conclusion: The analyses show two important issues that require further study:

• Increasing AP use in the age groups ’15 to 19’, ‘20 to 24’, ’60 to 64’, ‘65 to 69’ and ’70 to 74’ years
• Very high AP use in patients ≥ 90 years old