Variability in market uptake of psychotropic medications in Europe reflects cultural diversity

J M Hoebert,L Van Dijk,H G M Leufkens,A K Mantel-Teeuwisse

doi:10.1186/s12913-017-2649-6

Abstract

BackgroundIn the last 20–30 years, many international studies have found substantial differences in the use of (older) psychotropic medication between European countries. The majority mentioned an important role for attitudes and beliefs towards psychotropic medication. So far, no studies have looked into the effects of cultural diversity on the use of new medications entering the market. As national cultures relate deeply to held values regarding, for example, what is seen as effective versus ineffective or safe versus dangerous, (cultural) diversity in decision making around the role of new medications in clinical practice may already be expected from the first day after market authorization.MethodsThis study examined the relation between cultural diversity, described in Hofstede’s model of cultural dimensions (Power Distance, Individualism, Masculinity, Uncertainty Avoidance, Indulgence and Long-Term Orientation) and utilization of three new psychotropic medications, namely aripiprazole, duloxetine and pregabalin in Europe. Country level sales data of the case study medications were correlated to country-specific scores of Hofstede’s cultural dimensions. IMS Health’s MIDAS database has been used for sales data (converted to Defined Daily Doses/1000 inhabitants/day) for the case study medications from the market authorization date in 2004 until December 2009 for 23 EU member states.ResultsConsumption of the case study medications was seen in all countries. In general, pregabalin was used more often than aripiprazole and duloxetine. In 2 years after market authorization, approximately 80% of all countries have reported use of all three molecules.Correlations between Hofstede dimensions individualism, long-term orientation and indulgence and total use of the case study medications tended to become stronger over time, but they were only statistically significant for indulgence at two years after market authorization (rho = 0.51, p = 0.014) and three years after market authorization (rho = 0.54, p = 0.008). A more detailed analysis showed (slight) variation by molecule.ConclusionsThis study is a first step in including cultural dimensions when explaining cross-national variation in the use of new medications. The results indicate that indulgence, however marginally, is a cultural aspect that relates to the utilization of new psychotropic medications, suggesting that within the cultural context, less regulation of social norms is a main factor in explaining cross-national variation in uptake of these medications.

Highlights

In the last 20–30 years, many international studies have found substantial differences in the use of psychotropic medication between European countries
The findings of a positive correlation for Central nervous system (CNS) medication use with indulgence corroborate our hypothesis with regard to this dimension and showed that cultural diversity plays a role in the level of use of the case study medications
If we apply restraint to medical situation and decision making, policy makers and/or physicians may suppress the use of new medications, especially when treatment costs are higher and added therapeutic value is unknown compared to the already existing options and positive effects may vary between individuals

Summary

Introduction

In the last 20–30 years, many international studies have found substantial differences in the use of (older) psychotropic medication between European countries. Studies have already shown the relevance of cultural diversity in the use of antibiotics [6, 7] These studies showed that the cross-national differences in use of antibiotics in ambulatory care are potentially explained by national cultural differences resulting from varying perceptions and influences. Psychotropic medication is another area where differences in medication use across Europe seem to be related to cultural diversity [8, 9]. An international perspective on pediatric psychopharmacology (2008) stated “the cultural context seems to exert a greater influence on the identification and management of psychiatric disorders than on other areas of medication”[12]

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