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Objective: To assess the spatial accessibility and inequality of antidepressants and its correlation with VBP (Volume-based procurement) policy using procurement data from four representative Chinese cities between 2018 and 2020., Methods: The least-cost-path algorithm was employed to calculate travel time from each population point to the nearest medical institution. Gini coefficient and Theil index were utilized to measure accessibility and inequality. OLS (Ordinary Least Squares) and mediation analysis were used to investigate potential statistical relationships., Results: Under the influence of the VBP policy, we observed varying degrees of growth in the procurement volumes of two antidepressants across different cities (Escitalopram: Beijing 30.3%, Shanghai 26.2%, Ningbo 37.4%, Harbin 25.7%; Paroxetine: Beijing 28.2%, Shanghai 1.2%, Ningbo 50.2%, Harbin 590.5%). The increase in the procurement volumes of antidepressants across cities was primarily driven by generic drugs (Escitalopram: Beijing 159.8%, Shanghai 75.0%, Ningbo 146.4%, Harbin 146.3%; Paroxetine: Beijing 67.3%, Shanghai 4.9%, Ningbo 58.0%, Harbin 15,758.3%). In the results on spatial inequality, we observed annual improvements across all cities, with more pronounced progress in economically underdeveloped regions (Escitalopram: Gini in Harbin decreased by 10.6%; Paroxetine: Gini in Harbin decreased by 32.6%). In Beijing, the substitution of generic escitalopram was found to be a partial mediating factor in the improvement of spatial inequality (ACME = -0.00, p-value = 0.01; ADE = -0.00, p-value = 0.02). In Harbin, the substitution of generic paroxetine was identified as a complete mediating factor for spatial inequality (ACME = -0.04, p-value = 0.01; ADE = 0.01, p-value = 0.14)., Conclusions: This study found that the spatial accessibility and inequality of antidepressant medications gradually improved under the influence of the VBP policy. These improvements can be partially attributed to the substitution of generic drugs., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 Xue et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: The prescribing of antidepressants and antipsychotics to children has increased worldwide, but little is known about how changes in drug funding policy influence the practice. In 2018, Ontario introduced a universal pharmacare program (OHIP+) for children and youth, amending it in April 2019 to cover only those without private insurance. We examined the association of these policy changes with antipsychotic and antidepressant medication prescribing., Methods: We conducted a population-based study of antidepressant and antipsychotic medication dispensing to children ≤ 18 years old between September 1, 2014, and February 29, 2020. We obtained dispensing data from the IQVIA Geographic Prescription Monitor database, and used interventional autoregressive integrated moving average models to examine whether the implementation of OHIP + and its subsequent revision were associated with changes in dispensing., Results: The implementation of OHIP + was not associated with changes in the rate of antidepressants (-19.3 units per 1,000 population; 95% confidence interval [CI]: -41.7 to 3.1) or antipsychotics (+ 1.0 unit per 1,000 population; 95% CI: -5.4 to 7.5) dispensed. Similarly, subsequent changes to the program restricting coverage to children without private insurance were not associated with antidepressant (0.3 units per 1,000; 95% CI: -7.4 to 7.9) or antipsychotic (1.0 units per 1,000; 95% CI: -0.9 to 2.9) dispensing trends., Conclusion: Implementation of a publicly-funded pharmacare program did not influence trends in antidepressant or antipsychotic medication dispensing among children., Competing Interests: Declarations. Ethics approval and consent to participate: The study was performed on an aggregated database of medicines volume and sales data, without including patients or patients’ data. Hence, ethics approval was not required and consent to participate was not needed. Consent for publication: Not applicable. Competing interests: Melanie Penner has received consulting fees for unrelated work from Addis & Associates/Roche and from the Government of Nova Scotia. Mina Tadrous has received consulting fees for unrelated work from Green Shield Canada and the Canadian Agency for Drugs and Technologies in Health. Tara Gomes has received funding from the Ontario MOH for unrelated work. Tony Antoniou has no competing interests. Sophie Kitchen has no competing interests. Kathleen Pajer has no competing interests. William Gardner has no competing interests. Muhammad Mamdani has no competing interests. Yona Lunsky has no competing interests. David Juurlink has no competing interests., (© 2025. The Author(s).)

Objective: This post hoc analysis of the ESCAPE-TRD trial compared work productivity loss (WPL) and related costs among patients with treatment-resistant depression (TRD) receiving esketamine nasal spray or quetiapine extended release in combination with an oral antidepressant., Methods: Adults with TRD randomized to receive esketamine (56/84 mg) or quetiapine (150-300 mg) combined with ongoing antidepressant therapy were included. WPL was assessed using the Work Productivity and Activity Impairment questionnaire. Least squares (LS) mean WPL change versus baseline (treatment initiation date), and LS mean differences (MDs) between esketamine and quetiapine cohorts were reported at weeks 8-32 of treatment using mixed models for repeated measurements. Per patient productivity cost savings were estimated using mean 2021 weekly wages from US Bureau of Labor Statistics., Results: The esketamine cohort included 165 patients, and quetiapine cohort included 156 patients. At baseline, total WPL was 77.0% and 72.5% in the esketamine and quetiapine cohorts, respectively. By week 8, total WPL decreased from baseline by 30.3 and 17.3 percentage points (pp) in the esketamine and quetiapine cohorts (MD = 13.0 pp; 95% confidence interval [CI], 6.3-19.8 pp), resulting in weekly cost savings of $363 and $207 (MD = $156; 95% CI, $76-$237), respectively. By week 32, total WPL decreased from baseline by 45.3 pp and 32.5 pp in the esketamine and quetiapine cohorts (MD = 12.7 pp; 95% CI, 4.7-20.7 pp), with weekly cost savings of $543 and $390 (MD = $153; 95% CI, $57-$250), respectively., Conclusion: Among employed adults with TRD, esketamine treatment was associated with significantly larger improvements in WPL and related costs compared to quetiapine, suggesting greater benefits from patient well-being and employer perspectives., (© Copyright 2025 Physicians Postgraduate Press, Inc.)