Outpatient benzodiazepine utilization in Croatia: drug use or misuse

Background Benzodiazepines are commonly prescribed medications, especially among elderly, despite known risks and guidelines focused on short term usage. There is an increased trend of benzodiazepine consumption in Croatia. Consumption of anxiolytics in 2015 and 2016 in Croatia can almost entirely be ascribed to benzodiazepines, with diazepam being the most commonly prescribed drug, followed by alprazolam. Objective The aim of this study was to examine benzodiazepine utilization habits among the Croatian population. Setting This study was conducted on the national level, based on digital prescribing data. Method Data regarding the prescription of anxiolytics in Croatia was sourced and analyzed from the Croatian Health Insurance Fund database for the years 2015 and 2016. Drugs included in the study were classified according to The Anatomical and Therapeutic Classification of Medicines System, and consist of several chemical therapeutic subgroups (N05BA, N05BC, N05CD, N05CF). Main outcome measures The prescribing frequency of the most often prescribed benzodiazepines in Croatia. Results The total number of benzodiazepine prescriptions was 5,085,695 in 2015, and 5,294,075 in 2016; this represents a 208,380 increase in prescriptions, or 4.1% more than the previous year. The number of patients who utilized benzodiazepines showed an increase from 860,664 (8.67%) in 2015 to 876,046 (8.76%) in 2016. In relation to gender, benzodiazepine consumption was higher among female patients in all age groups, with the number of utilized benzodiazepine prescriptions per patient being highest in the oldest age group (80+), comprising 7 prescriptions per patient in a 12 months period. Conclusion Increased utilization and long-term treatment with benzodiazepines remains a serious challenge for the health care system in Croatia. National prescription guidelines, improved control of benzodiazepine usage and prescriptions, along with restricted release drug lists, should all be considered as potential measures to rationalize benzodiazepine prescription, control unnecessary expenditure in the country and improve the well-being of the patients.