Supplementary file 2_Nationwide epinephrine auto-injector dispensing in Greece: a drug-utilization study providing insights into anaphylaxis epidemiology and emergency-treatment preparedness.docx

Epinephrine auto-injector (EAI) dispensing cannot identify confirmed events or individual patients, but it is an epidemiologically relevant medication-use endpoint because EAIs are supplied to people with prior anaphylaxis or a clinically judged risk of future anaphylaxis.</p>Objective<p>To quantify nationwide EAI dispensing in Greece as a drug-utilization and emergency-treatment-preparedness benchmark and, secondarily, derive scenario-based incidence-compatible and prevalence-equivalent indicators relevant to the epidemiology of anaphylaxis.</p>Methods<p>This nationwide retrospective drug-utilization study analyzed aggregated net Anapen® DUO pack counts from reimbursed and non-reimbursed retail and hospital pharmacy channels during March 2015-March 2017, when it was the only EAI marketed nationally.

Directly observed pack flow was primary, utilization by EAI strength was analyzed at the population level using age-equivalent denominators, expiry timing was examined conditionally, and scenario outputs were deterministic sensitivity analyses.</p>Results<p>During 25 months, 33,986 twin-packs were recorded (153.2 packs per 100,000 person-years). The final 12-month rate was 154.0 per 100,000 population. Using age-equivalent population denominators, 150-microgram dispensing intensity was 5.8-fold higher than 300-microgram intensity.