Treatment patterns, healthcare resource utilization, and costs following first-line antidepressant treatment in major depressive disorder: a retrospective US claims database analysis

Abstract

BackgroundAlthough the symptoms of major depressive disorder (MDD) are often manageable with pharmacotherapy, response to first-line antidepressant treatment is often less than optimal. This study describes long-term treatment patterns in MDD patients in the United States and quantifies the economic burden associated with different treatment patterns following first-line antidepressant therapy.MethodsMDD patients starting first-line antidepressant monotherapy and having continuous enrollment ≥12 months before and ≥24 months following the index date (i.e., the first documented prescription fill) were selected from the Truven Health Analytics MarketScan (2003–2014) database. Based on the type of first treatment change following initiation, six treatment cohorts were defined a priori (“persistence”; “discontinuation”; “switch”; “dose escalation”; “augmentation”; and “combination”). Treatment patterns through the fourth line of therapy within each cohort, healthcare resource utilization (HCRU), and cost analyses were restricted to patients with adequate treatment duration (defined as ≥42 days) in each line (analysis sub-sample, N = 21,088). HCRU and costs were described at the cohort and pattern levels. Treatment cohorts representing <5% of the analysis sub-sample were decided a priori not to be analyzed due to limited sample size.Results39,557 patients were included. Mean age was 42.1 years, 61.1% of patients were female, and mean follow-up was 4.1 years. Among the analysis sub-sample, the discontinuation (49.1%), dose escalation (37.4%), and switch (6.6%) cohorts were the most common of all treatment cohorts. First-line antidepressant discontinuation without subsequent MDD pharmacotherapy (22.9%) and cycling between discontinuation and resumption (11.2%) were the two most common treatment patterns. Median time to discontinuation was 23 weeks. The switch cohort exhibited the highest HCRU (18.9 days with medical visits per-patient-per-year) and greatest healthcare costs ($11,107 per-patient-per-year) following the index date. Treatment patterns representing a cycling on and off treatment in the switch cohort were associated with the greatest healthcare costs overall.ConclusionA high proportion of patients discontinue first-line antidepressant shortly after initiation. Patterns representing a cycling on and off treatment in the switch cohort were associated with the highest healthcare costs. These findings underscore challenges in effectively treating patients with MDD and a need for personalized patient management.

Treatment patterns and sequences of pharmacotherapy for patients diagnosed with depression in the United States: 2014 through 2019

“…There has been limited prior research examining depression treatment sequences and the current work substantially expands upon this groundwork. Gauthier et al [13] examined patterns of switches, combinations, dose escalation, and discontinuation of antidepressants in general, [14], used a similar methodology to identify depression treatment sequences in multiple databases; however, this analysis did not capture combination therapy or use of non-antidepressant medication classes, among other differences in the approach. Our study leveraged prescription claims data from four patient populations representing a broad cross-section of the US population, including commercially insured individuals, those receiving Medicare, and individuals on Medicaid.…”

Treatment Patterns and Sequences of Pharmacotherapy for Patients Diagnosed with Depression in the United States: 2014 through 2019

“…There has been limited prior research examining depression treatment sequences and the current work substantially expands upon this groundwork. Gauthier et al [10] examined patterns of switches, combinations, dose escalation, and discontinuation of antidepressants in general, but did not look at individual drugs or classes, and did not include non-antidepressant treatment classes. Hripcsak et al [11], used a similar methodology to identify depression treatment sequences in multiple databases; however, this analysis did not capture combination therapy or use of non-antidepressant medication classes, among other differences in the approach.…”

<p>Impact of Atypical Antipsychotics as Adjunctive Therapy on Psychiatric Cost and Utilization in Patients with Major Depressive Disorder</p>

“…Adult patients ≥18 years old with MDD were identified by the presence of at least one inpatient or two outpatient claims for MDD disorders (International Classification of Disease, 9th Revision, Clinical Modification [ICD-9-CM] codes: 296.2x, 296.3x; 4,14 or 10th revision [ICD-10-CM] codes: F32.x-F32.5, F32.9, F33.0x-F33.4x) in any diagnosis field of a claim during the study period, which differed between databases: 07/01/2014 to 09/30/2017 for MarketScan Commercial and Medicare Supplemental; 07/01/2014 to 06/30/2017 for MarketScan Medicaid; and 07/01/2014 to 09/30/2017 for Optum ( Figure 1).…”