Frequency of hospitalizations prior to and after conversion to a rebate pharmaceutical in depression patients in Germany.

BACKGROUND: The aim of this study was to investigate the frequency of hospitalization in depression patients with and without conversion to a rebate pharmaceutical and to show the negative consequences of rebate contracts on the health of patients with depression. METHODS: This retrospective study was performed using two databases that included data on ~ 10 millions patients gathered between July 2009 and June 2012. This study included adults (> 18 years) on an antidepressive drug therapy who had statutory health insurance with rebate contracts on antidepressive pharmaceuticals. RESULTS: In total, 47,968 patients on an antidepressive drug therapy were included in the persistence analysis using the IMS Disease Analyzer database. Of those, 26,651 patients were converted to a rebate product whereas 21,317 patients continued with the initial pharmaceutical product. After adjusting for the majority of demographic and clinical variables, the risk of hospitalization was 57% higher in patients who switched to a rebate pharmaceutical in comparison to patients who did not. When projected to the national level, this was found to equal an additional 34,157 patients hospitalized due to conversion to a rebate pharmaceutical resulting in direct inpatient costs amounting to 363.8 million EUR per year in Germany. CONCLUSIONS: Despite some limitations, this analysis presents a clear association between the initiation of rebate contracts and a negative impact on the health of patients on an antidepressive drug therapy.