(B-134) DARWIN EU® - Paracetamol prescribing in Europe: a descriptive analysis of incidence and prevalence rates

Background: Paracetamol is one of the most widely used medicines worldwide. However, there is limited knowledge about its prescribing patterns in Europe.

Objectives: To investigate trends in incidence rates (IR) and prevalence (PR) of paracetamol prescribing across Europe.

Methods: Cohort study informed by 7 European databases in the DARWIN EU® data network previously mapped to the OMOP Common Data Model: BIFAP (Spain); CPRD GOLD (UK); DK-DHR (Denmark); EMBD-ULSEDV (Portugal); IQVIA DA Germany (Germany); NAJS (Croatia); and UKBB (UK). Databases included data from primary care (CPRD GOLD, IQVIA DA Germany), hospital care (DK-DHR, EMBD-ULSEDV), both (BIFAP, NAJS) or others (UKBB).

All individuals present in each database at any time during the study period (2010-2023) with at least 1 year of observation were included. IR per 100000 person-years (PY) and PR (%) with 95% confidence intervals (CI) were estimated overall and stratified by sex, age (1-5, 6-11, 12-17, 18-29, 10-year age bands to >80), and formulation (oral tablets, oral capsules, oral/injectable liquid formulations, and rectal suppositories). Repeated outcomes per patient were allowed using a 60-day washout period.

Results: We included data from 78042138 individuals. IR per 100000 PY was 12686 (95% CI 12683 to 12689) in BIFAP, 9477 (9471 to 9483) in CPRD GOLD, 8282 (8277 to 8288) in DK-DHR, 8827 (8801 to 8853) in EMBD-ULSEDV, 1578 (1575 to 1580) in IQVIA DA Germany, 7590 (7580 to 7600) in NAJS, and 5625 (5605 to 5646) in UKBB. Corresponding figures for PR (%) were 65.1 (65.1 to 65.2), 31.4 (31.4 to 31.4), 27.3 (27.3 to 27.3), 53.1 (53.0 to 53.2), 5.2 (5.2 to 5.2), 27.3 (27.2 to 27.3), 17.4 (17.3 to 17.5). In general, figures were higher among females than males and increased with age. In BIFAP, CPRD GOLD and DK-DHR, IR among individuals aged >80 was 2 to 3 times greater than in those aged 70 to 79, and 4 to 6 times greater than in the overall population.

Oral tablet formulations obtained the highest estimates (PR ranged from 2.9 to 47.3%), while injectable liquid formulations were generally the least prescribed (PR ranged from 0 to 1.1%). Females had higher estimates than males across all formulations except for rectal suppositories, where the estimates were similar by sex. Individuals aged 1 to 5 years were more commonly prescribed with oral liquid formulations (PR from 0.9 to 49.1%) and rectal suppositories (PR from 0 to 22.2%) compared to the general population (PR from 0.1 to 12.5% for oral liquid formulations; from 0 to 1.5% for rectal suppositories).

Conclusions: We found substantial heterogeneity in IR and PR of paracetamol prescribing across data sources. In general, estimates were higher for females than males and increased with age. Age differences were observed across formulations.