Changes in healthcare resource use and costs associated with early versus delayed initiation of atypical antipsychotic adjunctive treatment in major depressive disorder

Seetasith, Arpamas; Greene, Mallik; Hartry, Ann; Burudpakdee, Chakkarin

doi:10.1080/13696998.2018.1484373

Cited by 7 publications

(2 citation statements)

References 38 publications

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“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Seetasith¹,

Greene²,

Hartry³

et al. 2019

CEOR

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PurposeMajor depressive disorder (MDD) is a chronic mental disorder with a substantial clinical and economic burden. Despite the efficacy of adjunctive atypical antipsychotics (AAP) for augmentation in patients with major depressive disorder (MDD) who failed first-line antidepressant therapy (ADT), little is known of the impact of AAP choices on healthcare resource use and costs in real-world practice. Therefore, this study compared real-world healthcare utilization and costs in patients with MDD treated with brexpiprazole or extended-release (XR) quetiapine as adjunctive treatment to ADT.Patients and methodsAdults with MDD starting adjunctive treatment with brexpiprazole (n=844) or extended-release (XR) quetiapine (n=688) were identified in the adjudicated health plan claims data (07/2014 – 09/2016). Resource use and healthcare costs in the 6 months following treatment initiation were compared between non-matched populations, and between propensity score-matched groups, and by multivariable regression analyses.ResultsDuring follow-up, unadjusted all-cause hospitalization (6.6% vs 12.5%) and ED visits (17.0% vs 27.5%) were lower with brexpiprazole compared to quetiapine XR (both p<0.001). Brexpiprazole-treated patients had significantly lower mean medical costs (US$6,421 vs US$8,545, p=0.0123) but higher mean pharmacy costs (US$7,401 vs US$4,691, p<0.0001) than quetiapine XR-treated patients did. Total healthcare costs were not significantly different between the two cohorts. Propensity score-matched comparisons of 397 patients in each cohort showed no statistically significant difference in all-cause hospitalization, ED visits, and total healthcare costs; and significantly lower medical costs (US$5,719 vs US$8,602, p=0.0092) but higher pharmacy costs (US$7,091 vs US$5,091, p=0.0007) in brexpiprazole compared to quetiapine XR. In multivariable regressions, brexpiprazole was associated with 16.1% lower medical costs (p=0.0186) and 9.4% higher total healthcare costs (p=0.0463) as compared to quetiapine XR.ConclusionSignificantly lower medical costs were observed in patients with MDD treated with brexpiprazole vs quetiapine XR.

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Section: Introductionmentioning

confidence: 99%

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

Seetasith¹,

Greene²,

Hartry³

et al. 2019

CEOR

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“…28 Second, unlike the clinical trials which involve in a very restricted study population, this study included a more generalizable and diverse sample of patients with a variety of insurance types. Third, as patients may not respond to AAPs right away, 25,29 the follow-up period of 12 months in our study allowed for a longer observation period. Fourth, this was the first study to compare brexpiprazole and aripiprazole.…”

Section: Discussionmentioning

confidence: 99%

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

Yan¹,

Greene²,

Chang³

et al. 2020

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Introduction: Patients with major depressive disorder (MDD) incur high costs, despite established treatment options. Adding an atypical antipsychotic (AAP) to antidepressant therapy has shown to reduce depressive symptoms in MDD, but it remains unclear with which adjunctive AAP to initiate. As economic burden is one factor that can influence treatment selection, this study's objective was to evaluate the impact of adjunctive AAP choice on psychiatric costs and healthcare utilization in MDD. Materials and Methods: This retrospective cohort study analyzed de-identified data from: (1) IBM ® MarketScan ® Commercial (C), Medicare Supplemental (MS), and MarketScan Multi-State Medicaid (M) Databases, and (2) Optum ® Clinformatics ® Datamart. Adult MDD patients were included if they had: initiated adjunctive AAPs during study identification period (7/1/15-9/30/16 MarketScan C/MS, and Optum; 7/1/15-6/30/16 MarketScan M), and ≥12 months of continuous enrollment before (baseline) and after (follow-up) first treatment date. Models included generalized linear models (GLMs) for psychiatric costs (total inpatient and outpatient services, excluding outpatient pharmacy costs), and a two-part model (logistic regression for psychiatric hospitalizations, GLM for psychiatric hospitalization costs among hospitalized patients); models were adjusted for baseline characteristics. Results: The final study sample consisted of 10,325 patients (7657 aripiprazole, 1219 brexpiprazole, 827 lurasidone, 622 quetiapine). Using brexpiprazole as reference, lurasidone and quetiapine users had $1662 and $3894 higher psychiatric costs, respectively. Psychiatric costs were not statistically significantly different between aripiprazole and brexpiprazole (p>0.05). Quetiapine users had $15,159 (p<0.001) higher psychiatric hospitalization costs among those hospitalized, and higher odds of psychiatric hospitalization [2.11 (1.46-3.04); p<0.001] compared to brexpiprazole users. No statistically significant differences observed in psychiatric hospitalization risk comparing aripiprazole and lurasidone with brexpiprazole (p>0.05). Conclusion: In MDD, brexpiprazole users had significantly lower psychiatric costs than lurasidone and quetiapine users, and significantly lower psychiatric hospitalization risk than quetiapine users. Adjunctive AAP choice may impact subsequent healthcare costs and utilization in MDD.

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The Use of Antipsychotic Medications in the Emergency Department: a Narrative Review

Van Remmen,

Jasani

2023

Curr Behav Neurosci Rep

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Changes in healthcare resource use and costs associated with early versus delayed initiation of atypical antipsychotic adjunctive treatment in major depressive disorder

Abstract: AAP treatment was associated with reductions in all-cause and MDD-related medical costs, primarily in decreased hospitalization. The reductions were largest among patients who initiated treatment in the first year.

Cited by 7 publications

References 38 publications

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

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

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

The Use of Antipsychotic Medications in the Emergency Department: a Narrative Review

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