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Economic burden associated with inadequate antidepressant medication management among patients with depression and known cardiovascular diseases: insights from a United States based retrospective claims database analysis
Aims
The current study examined the association between insufficient major depressive disorder (MDD) care and healthcare resource use (HCRU) and costs among patients with prior myocardial infarction (MI) or stroke.
Methods
This was a retrospective study conducted using MarketScan Claims Database (2010-2015). The date of the first MI/stroke diagnosis was defined as the cardiovascular disease (CVD) index date and the first date of a subsequent MDD diagnosis was the index MDD date. Adequacy of MDD care was assessed during the 90-days (i.e., profiling period) following the index MDD date using 2 measures: dosage adequacy (average fluoxetine equivalent dose of ≥20 mg/day for nonelderly and ≥10 mg/day for elderly patients) and duration adequacy (measured as the proportion of days covered of 80% or higher for all MDD drugs). Study outcomes included all-cause and CVD-related HCRU and costs which were determined from the end of the profiling period until the end of study follow-up. Propensity-score adjusted generalized linear models (GLMs) were used to compare patients receiving adequate versus inadequate MDD care in terms of study outcomes.
Results
Of 1,568 CVD patients who were treated for MDD, 937 (59.8%) were categorized as receiving inadequate MDD care. Results from the GLMs suggested that patients receiving inadequate MDD care had 14% more all-cause hospitalizations, 4% more all-cause outpatient visits, 17% more CVD-related outpatient visits, 13% more CVD-related emergency room (ER) visits, higher per-patient per-year CVD-related hospitalization costs ($21,485 vs $17,756), higher all-cause outpatient costs ($2,820 vs $2,055), and higher CVD-related ($520 vs $434) outpatient costs compared to patients receiving adequate MDD care.Limitations: Clinical information such as depression severity, and frailty which are potential predictors of adverse CVD outcomes could not be ascertained using administrative claims data.
Conclusions
Among post-MI and post-stroke patients, inadequate MDD care was associated with a significantly higher economic burden.
Authors
S Bangalore, R Shah, X Gao, E Pappadopulos, C G Deshpande, A Shelbaya, R Prieto, J Stephens, R Chambers, P Schepman, R S McIntyre
Journal
Journal of Medical Economics
Therapeutic Area
Cardiology
Center of Excellence
Health Economic Modeling & Meta-analysis
Year
2019
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