(P-439) Paediatric Outpatient Prescriptions in Countries with Advanced Economies in the 21st Century: A Systematic Review and an International Comparison

Location: Poster Gallery-Pediatric Pharmacoepidemiology

Presenting Author(s)

MT

Marion Taine

EPI-PHARE (French National Agency for Medicines and Health Products Safety -ANSM- and French National Health Insurance -CNAM-), Saint-Denis, France, France

Co-Author(s)

LO

Lucile Offredo

EPI-PHARE (French National Agency for Medicines and Health Products Safety -ANSM- and French National Health Insurance -CNAM-), Saint-Denis, France, France
AW

Alain Weill

French National Health Insurance Fund (Assurance Maladie), France
RD

Rosemary Dray-Spira

EPI-PHARE, Epidemiology of Health Products (French National Agency for the Safety of Medicines and Health Products [ANSM], and French National Health Insurance [CNAM]), Saint-Denis, France, France
MZ

Mahmoud Zureik

EPI-PHARE, Epidemiology of Health Products (French National Agency for the Safety of Medicines and Health Products, and French National Health Insurance), France
MC

Martin Chalumeau

Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Centre of Research in Epidemiology and StatisticS, Université de Paris, F-75004 Paris, France, France

Background: International comparison of pediatric outpatient prescriptions is pivotal to identify inadequate practices at the national scale and guide corrective actions.

Objectives: To compare the paediatric outpatient prescription prevalence between countries with advanced economies.

Methods: Two independent reviewers systematically searched MEDLINE, EMBASE and websites for studies published since 2000 and reporting paediatric outpatient prescription prevalence (≥1 paediatric outpatient prescription/year in patients < 20 years old) in administrative databases from countries with advanced economies or large geographical areas within them. Risk of bias was assessed for exhaustiveness and representativeness. Prevalence rate ratios (PRRs) were used to compare the highest and the lowest paediatric outpatient prescription prevalence among studies, overall and then by levels 1, 2 and 5 of the Anatomical Therapeutic Chemical (ATC) classification, stratifying on non-prescription drug (NPD) status.

Results: We included 11 studies that used regional (n=4) and national (n=7) medico-administrative databases in 11 countries (32,552,550 children). The overall risk of bias was low. Prevalence of ≥1 paediatric outpatient prescription/year ranged from 480‰ in Sweden to 857‰ in France (PRR=1.79). Among the 8 studies reporting ATC level 1 POPs, overall, France had the highest paediatric outpatient prescription prevalence and Denmark and The Netherlands the lowest. Among the 8 studies reporting ATC level 2 paediatric outpatient prescriptions without NPDs, the PRR was 6.4 for antibiotics between New Zealand and The Netherlands and 109.0 for systemic corticosteroids between France and Denmark. Among the 7 studies reporting ATC level 5 paediatric outpatient prescriptions without NPDs, the highest annual paediatric outpatient prescription prevalence was for amoxicillin in New Zealand (290‰), France (278‰) and The Netherlands (89‰); amoxicillin-clavulanate in Italy (199‰); and phenoxymethylpenicillin in Denmark (96‰), Sweden (95‰) and Norway (75‰).

Conclusions: The large between-country differences observed in paediatric outpatient prescriptions cannot be explained by epidemiologic variations in diseases and may rather reflect massive inappropriate prescriptions. The findings may guide educational campaigns and/or regulatory decisions in some countries.