Stakeholder Insight: Anxiety Disorders - More Than Just a Comorbidity

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Publication Date: 2004-03-18

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Anxiety disorders are considered the most prevalent of psychiatric disorders. However, poor diagnosis rates and treatment outcomes mean that there is still considerable scope for manufacturers to move into the anxiety market. Based on 180 interviews with primary care physicians and psychiatrists, this report will analyze the commercial opportunities in the anxiety disorders market

Scope

Prevalence and diagnosis rates of anxiety disorders (including prevalence of comorbidity with other psychiatric disorders)

In-depth analysis of first- and second-line treatment choices

Key differences in treatment practices for acute versus chronic anxiety and comorbid anxiety

Evaluation of key attributes influencing drug choice and physician perception of current drug therapies to identify greatest unmet needs in treatment

Report Highlights
Despite a fifth of the total population across the seven major markets suffering from an anxiety disorder only a quarter of these individuals are diagnosed and therefore treated. As a result, drug manufacturers are failing to maximize revenues from the anxiety disorders market. Investment in awareness campaigns is essential.

Paroxetine is the gold standard treatment for anxiety disorders across the seven major markets. Nonetheless, opportunities still exist for manufacturers to gain market share in anxiety disorders and countries where the uptake of paroxetine has been less marked.

With almost a third of patients requiring second-line therapy, there is a significant need for anxiety drugs with improved efficacy. Drug developers must begin investing in clinical trials for anxiety specific drugs that demonstrate improved efficacy over current therapies.

Reasons to Purchase

Assess the size of the drug-treated population by gaining an understanding of the prevalence of anxiety with comorbid psychiatric disorders

Target physicians more effectively, through an understanding of prescribing behavior

Identify commercial opportunities by benchmarking current products and assessing unmet needs and future market potential

CHAPTER 1 EXECUTIVE SUMMARY - page 3
- Scope of the analysis - page 3
- Datamonitor insight into the anxiety disorders market - page 4
  - Despite approximately a fifth of the total population across the seven major markets suffering from an anxiety disorder only a quarter of these individuals are diagnosed and therefore treated. As a result, drug manufacturers are failing to maximize potential revenues from the anxiety disorders market. Investing in awareness campaigns would provide a significant boost to revenues. - page 4
  - Paroxetine is considered the gold standard treatment for anxiety disorders across the seven major markets. Manufacturers wishing to challenge the leading position must be able to demonstrate superior efficacy, onset of action, and fewer side effects than paroxetine. Nonetheless, opportunities still exist for gaining market share in anxiety disorders and within countries, such as Germany, where the uptake of paroxetine has been less marked. - page 6
  - With approximately 30% of patients requiring second-line therapy, there is a significant need for anxiety drugs with improved efficacy. Drug developers must begin investing in clinical trials for anxiety specific drugs. Demonstration to physicians of the benefits that the new chemical entities provide, compared to paroxetine, will be key to a successful uptake. - page 8
- Key metrics - page 9
TABLE OF CONTENTS - page 10
CHAPTER 2 INTRODUCTION AND SCOPE - page 19
- Coverage of the Stakeholder Insight Survey - page 19
  - Epidemiology and diagnosis of anxiety disorders - page 19
  - Referral patterns - page 19
  - Treatment of anxiety disorders - page 20
  - Drug profiles - page 20
CHAPTER 3 COUNTRY TREATMENT TREES - page 21
- US - page 22
- Japan - page 23
- France - page 24
- Germany - page 25
- Italy - page 26
- Spain - page 27
- UK - page 28
CHAPTER 4 EPIDEMIOLOGY AND PATIENT SEGMENTATION - page 29
- Key findings - page 29
- Definitions and classification - page 30
- Etiology of anxiety disorders - page 31
  - Generalized anxiety disorder - page 32
  - Panic disorder - page 32
  - Social anxiety disorder - page 33
  - Acute stress disorder - page 33
  - Obsessive-compulsive disorder - page 34
  - Post-traumatic stress disorder - page 35
  - Premenstrual dysphoric disorder - page 35
  - Agoraphobia - page 36
  - Specific phobias - page 36
- Epidemiology of anxiety - page 37
  - Prevalence of anxiety - page 37
  - Gender and age - page 39
- Segmentation of anxiety disorders - page 43
  - Acute versus chronic anxiety - page 43
  - Prevalence of anxiety disorder types - page 46
- Comorbidities of anxiety disorders - page 64
  - Generalized anxiety disorder - page 65
  - Panic disorder - page 65
  - Social anxiety disorder - page 65
  - Post-traumatic stress disorder - page 66
  - Premenstrual dysphoric disorder - page 66
- Prevalence of comorbidities across the seven major markets - page 67
CHAPTER 5 DIAGNOSIS AND TREATMENT - page 75
- Key findings - page 75
- Classification of anxiety disorders - page 76
  - ICD-10 classification - page 77
  - DSM-IV classification - page 78
- Diagnostic criteria - page 78
  - Panic disorder - page 78
  - Obsessive-compulsive disorder - page 79
  - Generalized anxiety disorder - page 80
  - Post-traumatic stress disorder - page 81
  - Acute stress disorder - page 82
  - Social anxiety disorder - page 84
  - Specific phobias - page 84
  - Agoraphobia - page 85
  - Premenstrual dysphoric disorder (PMDD) - page 85
  - Anxiety disorder not otherwise specified - page 86
  - Other anxiety disorders - page 87
- Diagnosis - page 87
  - Diagnosis rates - page 89
  - Referral patterns - page 93
- Treatment of anxiety disorders - page 99
  - Treatment guidelines - page 99
  - Drug overview - page 104
CHAPTER 6 PRESCRIBING TRENDS AND INFLUENCING FACTORS - page 106
- Key findings - page 106
- Introduction - page 107
- Prescribing trends - page 107
  - Pharmacological versus non-pharmacological treatment - page 107
  - Treatment priority in comorbid patients - page 109
  - Treatment lines - page 111
- Treatment of anxiety disorders - page 114
  - Treatment of acute versus chronic anxiety - page 114
  - Treatment of generalized anxiety disorder - page 115
  - Treatment of panic disorders - page 121
  - Treatment of social anxiety disorder - page 126
  - Treatment of acute stress disorder - page 131
  - Treatment of obsessive-compulsive disorder - page 136
  - Treatment of post-traumatic stress disorder - page 141
  - Treatment of premenstrual dysphoric disorder - page 146
  - Treatment of agoraphobia - page 151
  - Treatment of specific phobia - page 156
CHAPTER 7 IMPROVING TREATMENT OUTCOMES - page 161
- Key findings - page 161
- Prescribing influences - page 162
- Unmet needs - page 164
  - Physician education - page 165
  - Patient compliance - page 166
  - Efficacy - page 168
- Product development - page 169
  - Pregabalin - page 170
  - Pagoclone - page 170
  - LY 544344 - page 171
- Bibliography - page 172
- Physician research methodology - page 179
  - Physician sample breakdown - page 179
- Contributing experts - page 183
- The survey questionnaire - page 184
  - Physician details - page 184
  - Epidemiology of anxiety disorders - page 185
  - Referral patterns - page 189
  - Treatment - page 192
  - Comorbid conditions - page 198
  - Acute versus chronic - page 199
  - Drug profiles - page 202
- About Datamonitor - page 204
  - About Datamonitor Healthcare - page 204
  - Datamonitor Healthcare's research and analysis methodologies - page 205
- Datamonitor Healthcare's therapy area capabilities - page 205
  - About the CNS analysis team - page 206
  - Datamonitor Healthcare's Consulting expertise - page 207
  - Key therapy team members - page 208
- Disclaimer - page 210

List of Tables
Table 1: Prevalence of anxiety disorders across the seven major markets, 2003 - page 37
Table 2: Prevalence rate of sub-categories of anxiety disorder in the general population across the seven major markets - page 46
Table 3: Comparison of prevalence rates of anxiety disorders in the general population - page 48
Table 4: Prevalence of panic disorder in five of the major markets - page 51
Table 5: Prevalence of SAD in four of the major markets - page 53
Table 6: Prevalence of OCD - page 57
Table 7: Prevalence of a comorbid psychiatric condition with anxiety disorders across the seven major markets - page 64
Table 8: ICD-10 classification codes for anxiety disorders - page 77
Table 9: DSM-IV-TR classification codes for anxiety disorders - page 78
Table 10: Population correctly diagnosed with anxiety disorders, 2003-11 - page 90
Table 11: Proportion of patients diagnosed with an anxiety disorder that fall into each sub-category, 2003 - page 92
Table 12: Proportion of patients referred to different medical professional by PCPs, 2003 - page 96
Table 13: Proportion of patients referred to psychiatrist by different medical professionals - page 98
Table 14: WFSBP guidelines for panic disorder and agoraphobia treatment - page 100
Table 15: WFSBP guidelines for GAD treatment - page 101
Table 16: WFSBP guidelines for SAD treatment - page 102
Table 17: WFSBP guidelines for OCD treatment - page 103
Table 18: WFSBP guidelines for PTSD treatment - page 104
Table 19: Advantages and disadvantages of anti-anxiety drugs - page 105
Table 20: Proportion of patients receiving pharmacological and non-pharmacological treatment for anxiety disorders in the seven major markets - page 107
Table 21: Top prescription drugs used in first-line treatment of GAD in the seven major markets - page 117
Table 22: Top prescription drugs used in second-line treatment of GAD in the seven major markets - page 119
Table 23: Top prescription drugs used in first-line treatment of panic disorder in the seven major markets - page 122
Table 24: Top prescription drugs used in second-line treatment of panic disorder in the seven major markets - page 124
Table 25: Top prescription drugs used in first-line treatment of SAD in the seven major markets - page 127
Table 26: Top prescription drugs used in second-line treatment of SAD in the seven major markets - page 129
Table 27: Top prescription drugs used in first-line treatment of acute stress disorder in the seven major markets - page 132
Table 28: Top prescription drugs used in second-line treatment of acute stress disorder in the seven major markets - page 134
Table 29: Top prescription drugs used in first-line treatment of OCD in the seven major markets - page 137
Table 30: Top prescription drugs used in second-line treatment of OCD in the seven major markets - page 139
Table 31: Top prescription drugs used in first-line treatment of PTSD in the seven major markets - page 142
Table 32: Top prescription drugs used in second-line treatment of PTSD in the seven major markets - page 144
Table 33: Top prescription drugs used in first-line treatment of PMDD in the seven major markets - page 147
Table 34: Top prescription drugs used in second-line treatment of PMDD in the seven major markets - page 149
Table 35: Top prescription drugs used in first-line treatment of agoraphobia in the seven major markets - page 152
Table 36: Top prescription drugs used in second-line treatment of agoraphobia in the seven major markets - page 154
Table 37: Top prescription drugs used in first-line treatment of specific phobia in the seven major markets - page 157
Table 38: Top prescription drugs used in second-line treatment of specific phobia in the seven major markets - page 159
Table 39: Future anxiolytics - page 169
Table 40: US physician sample breakdown, 2003 - page 179
Table 41: Japan physician sample breakdown, 2003 - page 180
Table 42: France physician sample breakdown, 2003 - page 180
Table 43: Germany physician sample breakdown, 2003 - page 181
Table 44: Italy physician sample breakdown, 2003 - page 181
Table 45: Spain physician sample breakdown, 2003 - page 182
Table 46: UK physician sample breakdown, 2003 - page 182

List of Figures
Figure 1: Total drug treated anxiety disorders population in the seven major markets, 2003 - page 9
Figure 2: First- and second-line therapeutic strategies for different anxiety disorders in the US, 2003 - page 22
Figure 3: First- and second-line therapeutic strategies for different anxiety disorders in Japan, 2003 - page 23
Figure 4: First- and second-line therapeutic strategies for different anxiety disorders in France, 2003 - page 24
Figure 5: First- and second-line therapeutic strategies for different anxiety disorders in Germany, 2003 - page 25
Figure 6: First- and second-line therapeutic strategies for different anxiety disorders in Italy, 2003 - page 26
Figure 7: First- and second-line therapeutic strategies for different anxiety disorders in Spain, 2003 - page 27
Figure 8: First- and second-line therapeutic strategies for different anxiety disorders in the UK, 2003 - page 28
Figure 9: Prevalence of anxiety disorders across the seven major markets - page 38
Figure 10: Patient distribution: acute versus chronic anxiety - page 44
Figure 11: Prevalence of patients with specific symptoms of anxiety - page 45
Figure 12: Prevalence rate of different types of anxiety disorder in the general population across the seven major markets - page 47
Figure 13: Prevalence of GAD across the seven major markets - page 49
Figure 14: Prevalence of panic disorder across the seven major markets - page 50
Figure 15: Prevalence of SAD across the seven major markets - page 52
Figure 16: Prevalence of acute stress disorder across the seven major markets - page 54
Figure 17: Prevalence of OCD across the seven major markets - page 56
Figure 18: Prevalence of PTSD across the seven major markets - page 58
Figure 19: Prevalence of PMDD across the seven major markets - page 59
Figure 20: Prevalence of agoraphobia across the seven major markets - page 61
Figure 21: Prevalence of specific phobia across the seven major markets - page 62
Figure 22: Prevalence of other anxiety disorders across the seven major markets - page 63
Figure 23: Prevalence of comorbidities with anxiety disorders in the US - page 68
Figure 24: Prevalence of comorbidities with anxiety disorders in Japan - page 69
Figure 25: Prevalence of comorbidities with anxiety disorders in France - page 70
Figure 26: Prevalence of comorbidities with anxiety disorders in Germany - page 71
Figure 27: Prevalence of comorbidities with anxiety disorders in Spain - page 72
Figure 28: Prevalence of comorbidities with anxiety disorders in Italy - page 73
Figure 29: Prevalence of comorbidity with anxiety disorders in the UK - page 74
Figure 30: Anxiety disorders diagnostic decision tree (DSM-IV) - page 88
Figure 31: Population correctly diagnosed with an anxiety disorder - page 89
Figure 32: Diagnosis rates of anxiety disorders by PCPs versus psychiatrists - page 91
Figure 33: Proportion of patients that consult a physician directly (PCPs and psychiatrists) in the seven major markets - page 93
Figure 34: A comparison of proportion of patients that consult either a PCP or psychiatrist directly for anxiety - page 94
Figure 35: Proportion of patients referred to other medical professionals by PCPs - page 95
Figure 36: Proportion of patients referred to different medical professionals by PCPs - page 97
Figure 37: Proportion of patients referred to psychiatrist by different medical professionals - page 98
Figure 38: Proportion of patients receiving pharmacological, non-pharmacological or both forms of therapy in treatment of anxiety disorders in the seven major markets - page 108
Figure 39: Proportion of physicians across the seven major markets who believe anxiety or depression takes priority in the treatment of patients with comorbid anxiety and depression - page 110
Figure 40: Proportion of patients progressing to second-line therapy in the seven major markets - page 111
Figure 41: Length of time patients receive first-line therapy before progressing to second-line therapy in the seven major markets - page 112
Figure 42: Most frequently prescribed combination therapies used in the treatment of acute anxiety disorders in the seven major markets - page 114
Figure 43: Most frequently prescribed combination therapies used in the treatment of chronic anxiety disorders in the seven major markets - page 115
Figure 44: Top prescription drugs used for first-line treatment of GAD in the seven major markets - page 116
Figure 45: Top prescription drugs used in the second-line treatment of GAD in the seven major markets - page 118
Figure 46: Top prescription drugs used in the treatment of comorbid GAD and depression in the seven major markets - page 120
Figure 47: Top prescription drugs used for first-line treatment of panic disorder in the seven major markets - page 121
Figure 48: Top prescription drugs used in the second-line treatment of panic disorder in the seven major markets - page 123
Figure 49: Top prescription drugs used in the treatment of comorbid panic disorder and depression in the seven major markets - page 125
Figure 50: Top prescription drugs used for first-line treatment of SAD in the seven major markets - page 126
Figure 51: Top five prescription drugs used in the second-line treatment of SAD in the seven major markets - page 128
Figure 52: Top prescription drugs used in the treatment of comorbid SAD and depression in the seven major markets - page 130
Figure 53: Top prescription drugs used for first-line treatment of acute stress disorder in the seven major markets - page 131
Figure 54: Top prescription drugs used in the second-line treatment of acute stress disorder in the seven major markets - page 133
Figure 55: Top prescription drugs used in the treatment of comorbid acute stress disorder and depression in the seven major markets - page 135
Figure 56: Top prescription drugs used for first-line treatment of OCD in the seven major markets - page 136
Figure 57: Top prescription drugs used in the second-line treatment of OCD in the seven major markets - page 138
Figure 58: Top prescription drugs used in the treatment of comorbid OCD and depression in the seven major markets - page 140
Figure 59: Top prescription drugs used in first-line treatment of PTSD in the seven major markets - page 141
Figure 60: Top prescription drugs used in the second-line treatment of PTSD in the seven major markets - page 143
Figure 61: Top prescription drugs used in the treatment of comorbid PTSD and depression in the seven major markets - page 145
Figure 62: Top prescription drugs used for first-line treatment of PMDD in the seven major markets - page 146
Figure 63: Top prescription drugs used in the second-line treatment of PMDD in the seven major markets - page 148
Figure 64: Top prescription drugs used in the treatment of comorbid PMDD and depression in the seven major markets - page 150
Figure 65: Top prescription drugs used for first-line treatment of agoraphobia in the seven major markets - page 151
Figure 66: Top prescription drugs used in the second-line treatment of agoraphobia in the seven major markets - page 153
Figure 67: Top prescription drugs used in the treatment of agoraphobia and depression in the seven major markets - page 155
Figure 68: Top prescription drugs used for first-line treatment of specific phobia in the seven major markets - page 156
Figure 69: Top prescription drugs used in the second-line treatment of specific phobia in the seven major markets - page 158
Figure 70: Top prescription drugs used in the treatment of comorbid specific phobia and depression in the seven major markets - page 160
Figure 71: Key attributes most likely to influence drug choice - page 162
Figure 72: Rated performance of main drug classes used in the treatment of anxiety disorders - page 163
Figure 73: Rated performance of main drug classes used in the treatment of anxiety disorders - page 163
Figure 74: Key unmet needs - page 164
Figure 75: Datamonitor's Healthcare Consultancy - page 207
Figure 76: Datamonitor Healthcare's Therapeutic Consulting capabilities - page 208

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Stakeholder Insight: Anxiety Disorders - More Than Just a Comorbidity

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