Paediatric outpatient prescriptions in France between 2010 and 2019: A nationwide population-based study

Abstract

Background Paediatric outpatient prescription (POP) monitoring is pivotal to identify inadequate prescriptions and optimize drug use. We aimed at describing recent trends in POPs in France. Methods All reimbursed dispensations of outpatient prescribed drugs (excluding vaccines) were prospectively collected for the paediatric population (<18 years old) in the French national health database in 2010–2011 and 2018–2019 (mean 117,356,938/year). POP prevalence (proportion of children receiving ≥1 drug prescriptions/year) was calculated by age groups and compared by prevalence rate ratios (PRRs). Given the large sample size, 95% confidence intervals of POP prevalences and PRRs did not differ from estimates. Findings Among the 14,510,023 children resident in France in 2018–2019, mean POP prevalence was 857‰ children. Most prescribed therapeutic classes were analgesics (643‰), antibiotics (405‰), nasal corticosteroids (328‰), nonsteroidal anti-inflammatory drugs (NSAIDs) (244‰), antihistamines (246‰) and systemic corticosteroids (210‰). POPs decreased with age from 976‰ for infants to 782‰ for adolescents. Children <6 years old were notably more exposed to inhaled corticosteroids (PRR=3.06), non-penicillin beta-lactam antibacterial agents (PRR=3.05) and systemic corticosteroids (PRR=2.11) than older ones. The POP prevalence was slightly higher (PRR=1.04) during 2018–2019 than 2010–2011, with marked increases for anti-emetics (PRR=1.84), vitamin D (PRR=1.49), proton pump inhibitors (PRR=1.42), systemic contraceptives (PRR=1.24) and nasal corticosteroids (PRR=1.21) and decreases for propulsive/prokinetic agents (PRR=0.09), NSAIDs (PRR=0.73) and systemic antibiotics (PRR=0.88). Interpretation POP remained highly prevalent in France throughout the 2010s, especially for children <6 years old, with only a few improvements for selected therapeutic classes. These findings should prompt clinical guidance campaigns and/or regulatory policies. Funding Internal funding

Pediatric Outpatient Prescriptions in Countries With Advanced Economies in the 21st Century

“… 19 , 20 , 22 , 34 , 37 , 38 Websites of institutes of public health or drug agencies provided annual national POP prevalence for 5 countries (eTable 2 in the Supplement ). 39 , 40 , 41 , 42 , 43 The 11 included studies 19 , 20 , 22 , 34 , 37 , 38 , 39 , 40 , 41 , 42 , 43 performed in 11 different countries ( Table 1 ) were based on data for 35 552 550 pediatric patients from North America, 34 , 38 Europe, 19 , 37 , 39 , 40 , 41 , 42 , 43 and New Zealand. 20 There were 3 regional studies 34 , 37 , 38 and 8 national studies.…”

“… 20 There were 3 regional studies 34 , 37 , 38 and 8 national studies. 19 , 20 , 22 , 39 , 40 , 41 , 42 , 43 Data were collected between 2002 and 2019 and after 2010 for 7 studies. 20 , 22 , 39 , 40 , 41 , 42 , 43 Eight studies 19 , 20 , 37 , 39 , 40 , 41 , 42 , 43 reported annual overall POP prevalence, and 8 studies 19 , 20 , 22 , 39 , 40 , 41 , 42 , 43 reported annual prevalence by level 1 of ATC classification, 9 studies 19 , 20 , 22 , 34 , 38 , 40 , 41 , 42 , 43 by level 2, and 7 studies 20 , 22 , 39 , 40 , 41 , 42 , 43 by level 5 ( Figure 1 and Table 1 ).…”

“…For PODs, we performed sensitivity analyses by comparing studies reporting the same age groups ( Table 1 ). 19 , 20 , 22 , 34 , 37 , 38 , 39 , 40 , 41 , 42 , 43 Analyses were conducted from May to June 2021 with the statistical software Excel version 14.2.0 (Microsoft).…”

“…In 2008, Sturkenboom et al 18 , 19 studied POPs among 675 868 pediatric patients in 3 European countries and also reported high between-country PRs (5 to 20) for antibiotics and systemic corticosteroids. Since these publications, some studies 20 , 21 , 22 , 23 found an improvement or a worsening of inappropriate POPs over time in some OECD member countries. The only systematic review 24 of POPs, conducted in 2008, reported great variability in the prevalence of exposure to 1 or more drugs in pediatric patients over the course of a year (from 51% in Denmark to 70% in Greenland).…”

Opioid Analgesic Prescription in French Children: A National Population-Based Study

“…As in France, codeine was the most often prescribed opioid in all these countries except Denmark, where tramadol predominated. Other studies have shown higher prevalence of outpatient treatment prescriptions in France, and in particular analgesic therapy in children [ 13 , 14 ]. This can be explained by different reimbursement systems among countries [ 15 ].…”