Prescriptions for selective serotonin reuptake inhibitor (SSRI) sertraline accounted for an extra £113m during 2020 compared with 2019, research published in DARU Journal of Pharmaceutical Sciences has shown.
The authors say the increase was mainly attributed to shortages of the active pharmaceutical ingredient (API) and the resulting significant increase in the cost of generic medicines during the COVID-19 pandemic.
To assess the impact of the pandemic and associated lockdowns on antidepressant prescribing, the researchers examined antidepressant prescribing trends between January 2020 and August 2020 and compared them with similar periods in the three years preceding.
Prescribing data were obtained from the NHS Business Services Authority Prescription Cost Analysis database.
The research team also assessed the economic impact of the change in prescribing trends represented by changes in the cost incurred to NHS England.
On analysing the data, the researchers noted a sharp increase in the cost of antidepressants when the pandemic was at its peak in the UK, with costs surging to £35m in April 2020 — more than double the cost recorded during the same month in 2019.
The total number of antidepressant prescriptions dispensed between January 2020 and December 2020 was 78 million — a 4 million increase compared to the same period in 2019. However, the researchers found that these 4 million items cost NHS England an extra £139m.
Among different classes of antidepressants, SSRIs and tricyclic antidepressants were the most frequently prescribed. Prescriptions for sertraline alone accounted for an extra £113m during 2020, compared with 2019.
Study author Hamid Merchant, subject leader in pharmacy at the University of Huddersfield, explained that the difference in cost was the result of shortages of the APIs during the pandemic coupled with a significantly higher cost of generic drugs.
“The increase in cost was enormous — most of the APIs were coming from India and China, lots of products being manufactured in Europe were receiving raw materials from India and China and their supply [of APIs] was affected,” Merchant told The Pharmaceutical Journal.
“We looked at generics versus brands prescribed and found that the brand prices were very stable during the pandemic but the generics became equal to the brands in their cost and that’s what caused this big jump,” he added.
Syed Shahzad Hasan, study author and senior research fellow at the University of Huddersfield, added: “When we found this trend, we called a few pharmacists and pharmacy owners and they told us that the price of the generic was almost the same as the brand; about £30 for sertraline, when it was previously £18 [for the same quantity].”
He added that they had called the same pharmacists again when they were checking the proofs of the paper in March 2021 and the price had remained the same.
In April 2020, The Pharmaceutical Journal revealed that supplies of sertraline were returning to stock after manufacturers reported “industry-wide” supply challenges, exacerbated by export bans and border closures implemented as a result of COVID-19.
On 23 April 2020, Accord Healthcare told The Pharmaceutical Journal that its sertraline products had been out of stock for approximately four weeks, owing to a shortage of the API.