Psychotropic medication use in Belgian youth (0-24 years), 2018-2023: Sales vs reimbursement data

Background

An increase in psychotropic medication use among youth has been observed in Belgium. However, no comprehensive national monitoring system exists. Two data sources are currently used to inform policy and public health authorities: Farmanet, a national reimbursement database, and IQVIA’s partial retail pharmacy sales data on reimbursed and non-reimbursed medicines. This study compares these sources to assess how well they capture psychotropic use by age and sex.

Methods

We performed a retrospective observational study and compared Farmanet and IQVIA on 0-24 patients, 2018-2023. Psychotropic are retrieved using ATC (Anatomical Therapeutic Chemical): antipsychotics (N05A), antidepressants (N06A), psychostimulants (N06B) and gabapentinoid analgesics (N02BF). Descriptive analyses were conducted by age and sex. Agreement between datasets was assessed using Pearson correlations and Bland-Altman plots (accounting for age and sex) for unique patient counts and defined daily doses per 10,000 inhabitants per day.

Results

Agreement between datasets was high for trends over time (r = 0.98, p < 0.001), with strong correlations across ATC groups. Bland-Altman comparisons showed similar age- and sex-specific patterns within expected limit (mean ±1.96 SD). A notable exception occurred for psychostimulants in people aged 20-24 years. Farmanet recorded fewer patients than IQVIA (e.g. females: 444 vs 10,537). Differences were otherwise small and mainly related to magnitude rather than trends.

Conclusions

Farmanet and IQVIA provide analogous information on trends and sex-age patterns of psychotropic medication use among Belgian youth. However, reimbursement databases can underestimate the use of a medication also accessible by out-of-pocket purchase, as seen for psychostimulants. Public health monitoring systems should therefore consider combining reimbursement and pharmacy sales data to strengthen surveillance of mental health treatment and support evidence-based policy decisions.

Key messages

• Farmanet and IQVIA data show similar trends and age-sex patterns of psychotropic medication use in Belgium.

• Reimbursement data may misrepresent psychotropic use in young adults. Changes in reimbursement schemes after age 18 highlight the need to combine multiple data sources for accurate monitoring.