The negative impact of rebate contracts on the health care of patients with depression in Germany.

BACKGROUND: Aim of this study was to show the negative consequences of rebate contracts on health care of patients with depression. Negative consequences were defined as therapy withdrawal, increased resource utilization and the frequency of switch-back to initial pharmaceutical product in patients with conversion to a rebate pharmaceutical. METHODS: This retrospective analysis was performed combining the information of 3 databases including information about 20 millions patients and 80% of all prescriptions in Germany. The time period of observation started 1 year before the initiation of rebate contracts. Observation time was 2 years. This study included adults (> 18 years) with an antidepressive drug therapy and who had a statutory health insurance with rebate contracts on antidepressive pharmaceuticals. RESULTS: The mean persistence was 329 days for patients, who were switched to a rebate product compared to 365 days for patients who stayed on the initial drug therapy (p < 0.0001). 29.9% of the patients who were converted to a rebate product switched back to the initial antidepressive drug therapy within 1 year. 1,871 additional patients would be hospitalized due to the conversion to a rebate pharmaceutical that caused direct inpatient costs amounting to 19.9 million EUR per year in Germany. CONCLUSIONS: Despite the above limitations this analysis presents a clear association between the initiation of rebate contracts and a negative impact on health care of patients with an antidepressive drug therapy.