Costs Associated With Changes in Antidepressant Treatment in a Managed Care Population With Major Depressive Disorder

Department of Economics, University of Minnesota, Duluth, 1318 Kirby Dr., LSBE 330F, Duluth, MN 55812, USA.
Psychiatric services (Washington, D.C.) (Impact Factor: 2.41). 12/2009; 60(12):1604-11. DOI: 10.1176/
Source: PubMed


This study determined whether persons with major depressive disorder who switch or augment antidepressant therapy have higher health care costs and productivity losses than those who do not.
Data from July 1, 2002, through June 30, 2006, were taken from a national employment-based medical and pharmacy claims database. Participants were required to have filled an antidepressant prescription, be treatment naïve six months before the index prescription, be continuously enrolled in the benefits plan at least six months before and 12 months after the index prescription, and have at least one outpatient-based medical claim for major depressive disorder. Participants were categorized according to whether they switched, augmented, or maintained (that is, neither switched nor augmented) their antidepressant therapy in the 12 months after the index prescription. Productivity losses were defined as days absent from work for medical visits multiplied by average daily wage. Multivariate analyses (generalized linear models) were used to compare costs per person in the year after the index prescription, and univariate analyses (Wilcoxon tests) were used to compare productivity losses per person.
Of the 7,273 individuals who met study criteria, 40.3% switched, 1.5% augmented, and 58.2% maintained the index antidepressant therapy. After the analyses controlled for baseline characteristics, mean total and depression-related health care costs, respectively, in the year after the index prescription were significantly greater for switchers ($9,288 and $1,388 per person) and for augmenters ($9,350 and $1,027) than for maintainers ($6,151 and $723). Mean total and depression-related productivity losses, respectively, were significantly greater for switchers ($2,081 and $680) and augmenters ($2,010 and $587) than for maintainers ($1,424 and $437).
Persons with major depressive disorder who switched or augmented antidepressant therapy within 12 months of treatment initiation had higher resource costs and productivity losses than those who did not.

Download full-text


Available from: Jennifer Schultz, Sep 21, 2015
  • Source
    • "While this study was restricted to patients who initiated therapy on SSRI medications only, Schulz and Joish [17] conducted a US claims study examining second-step interventions among 7,273 patients with MDD who initiated any antidepressant therapy from 2002 to 2006. In their sample, 40.3% experienced a switch following their initial antidepressant, 1.5% had an add-on medication, and 58.2% maintained their initial antidepressant monotherapy. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The objective of this research was to examine treatment patterns and health-care costs associated with second-step pharmacotherapy in patients with major depressive disorder (MDD) who initiated monotherapy with a selective serotonin reuptake inhibitor (SSRI) in 2010. This claims database study analyzed patients diagnosed with MDD who were prescribed a monotherapy SSRI, with the first prescription identified as the index date. Patients were required to be >=18 years old, to have continuous insurance coverage from 1 year prior (pre-index) through 1 year post (post-index) from the index date, and to have not received an antidepressant in the pre-index period. The analyses are descriptive of the patient characteristics, initial SSRI prescribed, most commonly prescribed second-step therapies, and annualized health-care costs. The identified patients (N = 5,012) were predominantly female (65.2%) with a mean age of 41.9 years. The most frequent index SSRIs were citalopram (30.1%) and sertraline (27.5%), and 52.9% of patients were prescribed a second-step pharmacotherapy during the post-index period. Add-on therapy occurred twice more frequently than switching treatments, with either anxiolytics (40.2%) or antidepressants (37.1%) as the most common classes of add-on pharmacological therapies. Patients who added a second medication or switched therapies had higher annualized medical costs compared with patients who continued their index SSRI or discontinued treatment. For patients who were initially treated with an SSRI therapy, approximately half were prescribed a second-step treatment. In this comprehensive claims analysis, many of these patients experienced the addition of second medication, rather than switching to a new therapy. Given the type of medications used, it is possible that second-step interventions were targeted toward resolution of residual symptoms; however, this work is limited by the use of claims data without information on dosing or clinical symptoms, side effects, or response. Findings from this study set the expectation that physicians and patients will most likely need to partner for additional interventions in order to achieve remission.
    Full-text · Article · Mar 2014 · Annals of General Psychiatry
  • Source
    • "The mean age at initial diagnosis was about 78 years for patients with predementia and 82 years for patients with dementia. Data used to assign gender to the model populations (about 30% male) were obtained from literature [29–31] rather than from the VA VISN 1 data as almost all patients in the study cohort were male. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The growing understanding of the use of biomarkers in Alzheimer's disease (AD) may enable physicians to make more accurate and timely diagnoses. Florbetaben, a beta-amyloid tracer used with positron emission tomography (PET), is one of these diagnostic biomarkers. This analysis was undertaken to explore the potential value of florbetaben PET in the diagnosis of AD among patients with suspected dementia and to identify key data that are needed to further substantiate its value. A discrete event simulation was developed to conduct exploratory analyses from both US payer and societal perspectives. The model simulates the lifetime course of disease progression for individuals, evaluating the impact of their patient management from initial diagnostic work-up to final diagnosis. Model inputs were obtained from specific analyses of a large longitudinal dataset from the New England Veterans Healthcare System and supplemented with data from public data sources and assumptions. The analyses indicate that florbetaben PET has the potential to improve patient outcomes and reduce costs under certain scenarios. Key data on the use of florbetaben PET, such as its influence on time to confirmation of final diagnosis, treatment uptake, and treatment persistency, are unavailable and would be required to confirm its value.
    Full-text · Article · Dec 2012 · International Journal of Alzheimer's Disease
  • [Show abstract] [Hide abstract]
    ABSTRACT: The basic principles of pharmacotherapy for depression are consistent among most US and western European guidelines. All recommend ≥6 months of antidepressant therapy and propose several alternatives in cases of inappropriate response. The aims of this analysis were to describe antidepressant treatment changes and treatment duration in patients undergoing treatment for a new episode of depression and to identify risk factors for treatment changes and treatment discontinuation. For this claims database analysis, adults and children treated with antidepressants for a new episode of depression in the time period from 2004 to 2006 were identified using the IMS LifeLink Health Plan Database. Treatment changes (defined as switches to an antidepressant or antipsychotic; combination with an antidepressant; or augmentation with lithium, an anticonvulsant, or an atypical antipsychotic) were described. Antidepressant treatment duration was assessed and described per treatment change. Risk factors for treatment change or discontinuation were identified using multivariate logistic regression (treatment change) or Cox regression (treatment duration). Of 134,287 patients identified using the database (mean [SD] age, 39.1 [14.9] years; 68.1% women), 31,123 (23.2%) had a treatment change, most commonly an antidepressant switch (12,735 [9.5%]) or combination (12,214 [9.1%]). Antipsychotics were introduced in <5% of patients. The median overall treatment duration (111 days) was shorter than that recommended in the guidelines (≥ 6 months). Index antidepressant class was significantly associated with treatment change (higher for tricyclic antidepressants [TCAs] [odds ratio (OR) = 1.59 (95% CI, 1.48-1.70)]; lower for selective serotonin reuptake inhibitors [OR = 0.87 (95% CI, 0.84-0.91)]) and duration (increased risk for early discontinuation for TCAs [hazard ratio (HR) = 1.36 (95% CI, 1.30-1.44)]; lower risk for late discontinuation for serotonin-norepinephrine reuptake inhibitors [HR = 0.81 (95% CI, 0.79-0.84)]). Indicators of depression severity or complexity (prescription by a mental health specialist, previous use of psychotropics, previous psychiatric hospitalization, and presence of psychosomatic comorbidities) were associated with a higher risk for treatment change and inconsistently associated with treatment duration. Two health plans were associated with increased risk for discontinuation (Medicaid, HR = 1.35 [95% CI, 1.28-1.42]; Medicare, HR = 1.38 [95% CI, 1.12-1.71]). Combination and augmentation strategies were associated with a lower risk for treatment discontinuation (combination, HR = 0.83 [95% CI, 0.81-0.86]; augmentation, HR = 0.75 [95% CI, 0.73-0.77]). Overall treatment duration was <30 days in 31,177 patients (26.2%) and >6 months in 54,502 (37.5%). In this claims database analysis, changes in antidepressant treatment involved 23.2% of patients. The median overall treatment duration was shorter than recommended by guidelines due to a quarter of patients having early treatment discontinuation.
    No preview · Article · Nov 2010 · Clinical Therapeutics
Show more