Search

Purpose: To describe temporal trends and assess factors associated with changes in the prescription of clomiphene citrate and gonadotropins between 2010 and 2017 in women with infertility aged 18–50 from metropolitan France. Methods: 6321 prevalent women from a representative sample of the national medico‐administrative database were identified. We performed a Cochran‐Armitage trend test and calculated the rate ratios. A Poisson regression was used to derive the incidence rate ratios, for each treatment class. Results: The prevalence rate and incidence rate of clomiphene citrate use significantly decreased by 20% (RR 0.80: 95% CI 0.71–0.90) and 23% (RR 0.77: 95% CI 0.66–0.89), respectively. Its initiation was higher in all age groups compared to the reference (18–24 years), with a downward gradient. It was also higher when the density of gynaecologists was higher and in disadvantaged areas. The prevalence rate and incidence rate of gonadotropin use increased by 11% (RR 1.11: 95% CI 1.01–1.22) and 33% (RR 1.33: 95% CI 1.14–1.55) respectively. Gonadotropin initiation was highest in the 31–35 age group, but it was also higher in the 25–30 and 36–40 age groups at a similar level (reference 18–24 years). Its initiation was higher when the density of gynaecologists was higher, but not associated with social deprivation. Conclusion: Our results showed an increase in gonadotropin use for infertility treatment in France during the 2010–2017 period and a decrease in clomiphene citrate use. Further work should be undertaken to analyse the use of these drugs in relation to women's care pathways. [ABSTRACT FROM AUTHOR]

Context Serious adverse events related to the use of domperidone and metoclopramide have been consistently reported in the literature for many years. This led to a restriction of their use in the early 2010s. Objective: The main objective was to analyse the evolution of antiemetic prescription rate in French general practise between 2006 and 2016. The secondary objectives were to highlight prescription transfers for metopimazine and to quantify the impact on health expenditures. Method: All patients from a representative sample of a national administrative claims database, the French national health insurance database, were included between 2006 and 2016. Trends in annual anti‐emetic prescription rates by general practitioners were analysed using logistic regression models adjusted for age, gender and the existence of cancer. The cost of theses changing prescription habits was quantified via Médic'AM, a public drug expenditure database. Results: Around 669 020 individuals were included with a mean 8‐year follow‐up; 48 634 patients received an anti‐emetic at least once between 2006 and 2016. Prescription rates for all antiemetics decreased significantly from 2.1% to 0.4%, especially for metoclopramide from 0.5% to 0.1%, for domperidone from 1.5% to 0.1% and for metopimazine from 0.4% to 0.2%, which is not in favour of prescription transfers. Expenses fell from 30 million euros in 2006 to 10 million in 2016. Conclusion: Decreases in anti‐emetic prescription rates and public health expenditures preceded the publication of official recommendations to reduce the use of metoclopramide and domperidone, without prescription transfers for metopimazine. [ABSTRACT FROM AUTHOR]