Earlier Versus Later Augmentation with an Antipsychotic Medication in Patients with Major Depressive Disorder Demonstrating Inadequate Efficacy in Response to Antidepressants: A Retrospective Analysis of US Claims Data

Abstract

IntroductionThere is little evidence regarding the most effective timing of augmentation of antidepressants (AD) with antipsychotics (AP) in patients with major depressive disorder (MDD) who inadequately respond to first-line AD (inadequate responders). The study’s objective was to understand the association between timing of augmentation of AD with AP and overall healthcare costs in inadequate responders.MethodsUsing the Truven Health MarketScan® Medicaid, Commercial, and Medicare Supplemental databases (7/1/09–12/31/16), we identified adult inadequate responders if they had one of the following indicating incomplete response to initial AD: psychiatric hospitalization or emergency department (ED) visit, initiating psychotherapy, or switching to or adding on a different AD. Two mutually exclusive cohorts were identified on the basis of time from first qualifying event date to first date of augmentation with an AP (index date): 0–6 months (early add-on) and 7–12 months (late add-on). Patients were further required to be continuously enrolled 1 year before (baseline) and 1 year after (follow-up) index date. Patients with schizophrenia or bipolar disorder diagnoses were excluded. General linear regression was used to estimate adjusted healthcare costs in the early versus late add-on cohort, controlling for baseline demographic and clinical characteristics, insurance type, medications, and ED visits or hospitalizations.ResultsOf the 6935 identified inadequate responders, 68.7% started an AP early and 31.3% late. At baseline, before AP augmentation, patients in the early add-on cohort had higher psychiatric comorbid disease burden (47.3% vs. 42.5%; p < 0.001) and higher inpatient utilization [mean (SD) 0.41 (0.72) vs. 0.27 (0.67); p < 0.001] than in late add-on cohort. During follow-up, the adjusted total all-cause healthcare cost was significantly lower in the early vs. late add-on cohort ($18,864 vs. $20,452; p = 0.046).ConclusionFindings of this real-world study suggest that, in patients with MDD who inadequately responded to first-line AD treatment, adding an AP earlier reduces overall healthcare costs.FundingOtsuka Pharmaceutical Development and Commercialization, Inc. and Lundbeck.Electronic supplementary materialThe online version of this article (10.1007/s12325-018-0838-2) contains supplementary material, which is available to authorized users.

<p>Real-World Economic Outcomes of Brexpiprazole and Extended-Release Quetiapine Adjunctive Use in Major Depressive Disorder</p>

“…Multiple meta-analysis studies from published clinical trials (up until 2010) also show that the use of adjunctive AAPs was significantly more effective than placebo or antidepressant therapy alone in terms of achieving remission or clinical response 18–21. Use of adjunctive AAP in patients with MDD also shows significant reductions in all-cause, and MDD-related hospitalizations and ED visits despite increases in pharmacy fills and physician office visits,22 and early treatment – within the first year of first antidepressant therapy or within six months of evidence of inadequate therapy – is associated with significantly lower all-cause cost23 and greater reduction in hospitalization and overall medical costs22 compared to delayed treatment. Three AAPs, including aripiprazole (2007), extended-release quetiapine (2009), and brexpiprazole (2015), are approved by the FDA as an adjunctive treatment for MDD 24–26.…”

Early augmentation by using neuromodulation in psychiatric disorder: a kaleidoscopic view

“…It was found that the patients receiving early augmentation had reduced healthcare expenditure. 6 Augmenting pharmacotherapy with cognitive behavior therapy in obsessive-compulsive disorder is found to be more effective in reducing the symptoms severe cases of obsessive-compulsive disorder. 7,8 In most conditions, psychotherapy (eg, cognitive behavior therapy) is introduced early in the course of treatment as an addition to the pharmacotherapy.…”

“…In a study, patients with major depressive disorder with inadequate response to antidepressants received early augmentation with antipsychotic medications. It was found that the patients receiving early augmentation had reduced healthcare expenditure 6 . Augmenting pharmacotherapy with cognitive behavior therapy in obsessive–compulsive disorder is found to be more effective in reducing the symptoms severe cases of obsessive–compulsive disorder 7 …”

Characteristics of Patients Experiencing Extrapyramidal Symptoms or Other Movement Disorders Related to Dopamine Receptor Blocking Agent Therapy

“…Since that time, their use has greatly expanded, and DRBAs are now used to treat a variety of psychiatric conditions including major depressive disorder, bipolar disorder, and irritability associated with autistic disorder. The importance of DRBA treatment in patients with first-break psychosis 1 and major depressive disorder not responding to first-line antidepressant monotherapy 2 has recently been demonstrated in terms of reduced hospital admissions and health care costs. Early initiation of long-acting injectable DRBA formulations has also garnered significant value by decreasing hospitalizations and overall costs within contemporary international practice models.…”