Mental health policy and practice across Europe: an overview

184 Mental health policy and practice
To access this data, we commissioned three customized studies from IMS Health
based on the data that they compile from over 120 countries, which includes, for the
countries chosen, drugs prescribed in hospital and sold through retail outlets. These
data provided the basis for calculations made by our team, and IMS has no responsibility
for these or our interpretations. The first two studies examined the situation in a
number of broad geographical regions in the decade from 1990 to 2000. The regions
selected were USA, Japan, the EU, South America (Argentina, Brazil, Mexico, Colombia,
Peru, Uruguay, Venezuela), South Africa (data for other countries in Sub-Saharan
Africa were not available) and Pakistan (12-year data for India were not available).
The third study examined the situation in the 15 countries which were member states
of the EU from 1993 to 2002. Unless otherwise stated, reference to ‘Europe’ in this
chapter is to the EU-15 data.
The first study contained data on market size in US dollars at ex-manufacturers
prices, adjusted according to the prevailing rates of exchange. The second contained
detailed breakdowns by molecules of the volume of drugs prescribed. The third
study provided country breakdowns of data for selected drug types in the countries of
the EU.
The principal comparative measure used is the SU. SUs are determined by taking the
number of counting units sold, divided by the standard unit factor which is the
smallest common dose of a product form as defined by IMS Health. For example, for
oral solid forms the standard unit factor is one tablet or capsule whereas for syrup
forms the standard unit factor is one teaspoon (5 ml) and injectable forms it is one
ampoule or vial. This is the best available measure for comparative purposes, but it is
far from perfect. For example, a 30-day pack of a product given four times a day will
contribute 120 SUs for each pack sold whereas a similar pack of a once daily product
will contribute only 30 SUs. Many more products now have once daily dosing regimes
than in the past. In such circumstances SU analyses can make it appear that the
market has collapsed even though the days of treatment will have remained constant
or increased. Therefore, there are some risks to using SUs for comparative purposes
over the time periods and the regions reported here, and where these are of particular
relevance we have tried to supplement SUs with other measures. Dates shown are
calendar years. Prices refer to total sales ex-manufacturer (not retail prices) in US
dollars at the exchange rate at the date in question. Figures credited to IMS Health are
based on that report, but the analysis, tables and figures are our own. Some drugs used
to treat psychiatric conditions, such as the anti-convulsants, are not included, as most
prescriptions for such drugs are for non-psychiatric conditions.
Wherever appropriate, the data is standardized to population size and expressed as
SU per 1000 population in the year in question. 2001 population data was used in the
calculations for the IMS Second Study, derived from the CIA World Factbook 2001, and
2003 population data was used for the IMS Second Study, derived from the CIA World
Factbook 2003, available at www.cia.gov/cia/publications/factbook/.
2 IMS Health: First Study.
3 The best historical work on the development of psychopharmacology has been done
by David Healy, and I draw extensively on this here: notably Healy (1997, 2001).
4 American Psychiatric Association (1994).
5 Notably by Husseini Manji and his team at the Laboratory of Molecular Pathophysiology
at the US National Institute of Mental Health, e.g. Manji et al. (2001).
6 Notably Duman and his team, e.g. Duman et al. (1997, 2001).
7 The DDD is the assumed average maintenance dose per day for a drug used for its
main indication in adults, and DDDs are assigned by the WHO Collaborating Centre
for Drug Statistics Methodology in Norway (www.whocc.no/atcddd/).
8 It is possible to calculate the conversion between SUs and DDDs, but this has to be