健保制度下抗憂鬱劑的世代分析及處方行為

The Prescription Pattern and Analyses of Antidepressants under the National Health Insurance Policy in Taiwan

目的：本研究使用健保資料庫研究各代抗憂鬱劑間競爭現象及處方行為。方法：由健保 資料庫中挑選診斷為憂鬱症的案例作為研究的對象，統計各抗憂鬱劑的處方數及使用量， 進而了解健保制度對抗憂鬱劑的世代競爭及處方行為的影響。結果：本研究顯示從1997 年 至2004 年，台灣憂鬱症人口增加逾一倍，抗憂鬱症藥品的總使用金額也隨之增加三倍。各 代抗憂鬱劑的使用金額成長，第三代抗憂鬱劑為研究期間憂鬱症的主流藥品，其使用百分比 及開立處方數逐年取代第一代抗憂鬱劑，第二代抗憂鬱劑使用情形維持穩定。以醫療層級來 看，各層級皆以第三代抗鬱劑為主，但第一代抗憂鬱劑在地區醫院及基層院使用的比例較 高。結論：第三代抗憂鬱劑的使用量超過第一代及第二代抗憂鬱劑。台灣健保制度明顯影響 憂鬱症的使用。抗憂鬱劑的競爭情形與波特的競爭理論相符合。

Background: In this study, we examined trends associated with various antidepressants competing in the Taiwanese market, based on data from the National Health Insurance (NHI) Research Database. Methods: The cases of patients diagnosed with depression were selected as the subjects of this study. The prescription and use of antidepressants were analyzed to shed light on the competition in the market and substitution of these drugs, as infl uenced by the NHI insurance system. Results: The data indicated that the number of patients diagnosed with clinical depression was increased twofold and that the associated expenditure on antidepressants was increased threefold between 1997 and 2004. We also observed the total incremental use of antidepressants in each category, indicating that thirdgeneration antidepressants continued to dominate market, and gradually replaced those of the fi rst-generation antidepressants. The use of second-generation antidepressants was found to have remained relatively unchanged. Among all levels of hospital organizations, third-generation antidepressants were found to be preferred. The medical staff at district hospitals and primary care clinics prescribed more fi rst-generation antidepressants than those at regional hospitals or medical centers. Conclusions: The use of third-generation antidepressants has surpassed that of fi rst- and second-generation. The non-free market drug reimbursement mechanism governed by NHI had infl uence on prescription patterns of antidepressants in hospitals. All aspects of competition among antidepressants are in line with the Porter’s theory of competition.