IMPACT OF SAFETY-RELATED REGULATION ON USE OF CODEINE IN TAIWANESE CHILDREN
Author(s)
Lin C1, Wang C1, Huang W1, Ke W1, Chao P1, Chen W1, Hsiao F2
1Taiwan Drug Relief Foundation, Taipei, Taiwan, 2National Taiwan University, Taipei, Taiwan
OBJECTIVES: Safety concerns regarding severe adverse events associated with codeine have resulted in policy decisions to restrict its use in pediatrics both in Taiwan and other countries. The aim of this study is to investigate the epidemiology and determinants of codeine use in Taiwanese children, and to assess whether changes in prescription trends reflected the impact of regulatory action. METHODS: A population-based study was performed using the 2003 -2010 Taiwan’s National Health Insurance Research Database. Patients under 18 years who experienced an outpatient visit for upper respiratory infection (URI) or cough were identified as the study population. During the 8-year study period, annual data of codeine prescription rates of URI/cough visits were reported, and the Cochran-Armitage trend test was used to analyze prescription trends over time. For each URI/cough visit, characteristics of the patient and the prescriber were collected, and multivariable logistic regression models were used to explore significant determinants associated with the use of codeine. RESULTS: There were 11,627,125 URI/cough visits in children during 2003-2010. The prescription rate of codeine decreased from 6.2% to 3.7% of visits from 2003 to 2010 (p<0.01 for trend) and plummeted after a regulatory action in 2007. Age-stratified analyses showed a greater reduction in the codeine prescription rates in children aged <2 (from 4.3% to 0.2%) and those aged 2-5 (from 7.0% to 3.6%). Noteworthy, physicians at clinics (OR 6.54, 95% CI ) and those in less urbanized area (OR , 95% CI ) prescribed codeine more frequently. Most of the codeine prescriptions were for multiple-ingredient products, and the proportion of therapeutic duplication was 41.1% in 2010. CONCLUSIONS: Although the prescription rate of codeine in Taiwanese children was greatly reduced after the regulatory action, more attention should be paid to the determinants of prescribing codeine and the high proportion of therapeutic duplication.
Conference/Value in Health Info
2016-09, ISPOR Asia Pacific 2016, Singapore
Value in Health, Vol. 19, No. 7 (November 2016)
Code
PIH28
Topic
Health Service Delivery & Process of Care
Topic Subcategory
Prescribing Behavior
Disease
Pediatrics