Impact of adherence to antidepressants on healthcare outcomes and costs among patients with type 2 diabetes and comorbid major depressive disorder

Vega, Charles; Becker, RV; Mucha, Lisa; Lorenz, B.; Eaddy, Michael; Ogbonnaya, Augustina

doi:10.1080/03007995.2017.1347092

Cited by 11 publications

(23 citation statements)

References 19 publications

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“…5 Although clinical guidelines emphasize the importance of adherence and persistence to antidepressants, adherence and persistence to antidepressants are suboptimal, with only 35%-55% of patients remaining adherent or persistent to antidepressant therapy at 6 months. [6][7][8][9][10] Commonly cited reasons for nonadherence or nonpersistence to antidepressants include lack of efficacy, 11 intolerability, 11 regimen complexity, 12 out-ofpocket costs, 12,13 and patient beliefs about antidepressant medications. 14,15 Both antidepressant nonadherence and nonpersistence are significant barriers to depression treatment effectiveness and subsequent remission, 4 and failure to achieve adequate response or remission with antidepressant therapy is associated with poorer clinical and functional outcomes, 16,17 increased health care resource utilization (HCRU) and costs, [16][17][18][19][20] and work productivity loss.…”

Section: What This Study Addsmentioning

confidence: 99%

Health care resource utilization and costs associated with nonadherence and nonpersistence to antidepressants in major depressive disorder

Sullivan

Tung

et al. 2021

JMCP

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Section: What This Study Addsmentioning

confidence: 99%

Health care resource utilization and costs associated with nonadherence and nonpersistence to antidepressants in major depressive disorder

Sullivan

Tung

et al. 2021

JMCP

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“…One possible explanation for our findings is that patients with poorly managed MDD are less able to effectively manage their comorbid chronic conditions. Consistent with this speculation, comorbid MDD and diabetes have been associated with suboptimal glycemic control and an increase in diabetes-related complications, which may be due to the fact that MDD can impair a patient’s self-management of T2D [ 15 ]. If this is true, more effective treatment of depressive symptoms may enable patients to better manage their chronic diseases.…”

Section: Discussionmentioning

confidence: 97%

“…Key to effective management of any chronic condition is patients’ adherence to prescribed therapy. Comorbid MDD has been previously shown to have a negative impact on treatment adherence for patients with CVD or T2D, which has been associated with poorer outcomes in some studies [ 15 , 17 ]. Medication nonadherence in patients with comorbid MDD and CVD occurs at a rate more than double that of patients without MDD [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

“…Adherence to antidepressant therapy in turn supports adherence to therapy for comorbid physical conditions and better physical health outcomes. For example, among patients with comorbid T2D and MDD, those with better adherence and persistence to antidepressants have demonstrated improved adherence to oral antidiabetic medications, better glycemic control, and lower total all-cause and medical costs [ 15 ]. In addition to the impact of adherence to antidepressant therapy in assisting patients to better manage comorbid health conditions, depression and both T2D and CVD also share certain common physiological pathways [ 4 , 6 ].…”

Section: Discussionmentioning

confidence: 99%

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Incremental burden of comorbid major depressive disorder in patients with type 2 diabetes or cardiovascular disease: a retrospective claims analysis

Kangethe

Lawrence

Touya

et al. 2021

BMC Health Serv Res

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Background The estimated prevalence of comorbid major depressive disorder (. MDD) is 11% in patients with type 2 diabetes (T2D) and 15–20% in those with cardiovascular disease (CVD). Comorbid MDD continues to be a significant source of economic burden to the healthcare system. Methods We assessed the incremental healthcare burden of comorbid MDD in patients with T2D or CVD. This real-world, retrospective, administrative claims study analyzed commercially insured adults with T2D or CVD diagnosed on at least 2 separate claims within 12 months of each other (between January 1, 2011, and September 30, 2018). CVD included congestive heart failure, peripheral vascular disease, coronary heart disease, and cerebrovascular disease. The study compared patients with and without MDD with either T2D or CVD. Study assessments included all-cause healthcare resource utilization (proportion of patients with hospitalization, emergency department [ED] visits, and outpatient visits) and cost. Results Patients were matched by propensity score for demographics and baseline characteristics, resulting in similar baseline characteristics for the respective subcohorts. After matching, 22,892 patients with T2D (11,446 each with and without MDD) and 28,298 patients with CVD (14,149 each with and without MDD) were included. At follow-up, patients with T2D and MDD had significantly higher rates of hospitalization (26.1% vs 17.4%, P < 0.0001) and ED visits (55.3% vs 43.0%, P < 0.0001) than those observed in patients without MDD. The total cost for patients with T2D and MDD at follow-up was significantly higher than for those without MDD ($16,511 vs $11,550, P < 0.0001). Similarly, at follow-up, patients with CVD and MDD had significantly higher rates of hospitalization (45.4% vs 34.1%, P < 0.0001) and ED visits (66.5% vs 55.4%, P < 0.0001) than those observed in patients without MDD. Total cost at follow-up for patients with CVD and MDD was significantly higher than for those without MDD ($25,546 vs $18,041, P < 0.0001). Conclusions Patients with either T2D or CVD and comorbid MDD have higher total all-cause healthcare utilization and cost than similar patients without MDD. Study findings reinforce the need for appropriate management of MDD in patients with these comorbid diseases, which in turn may result in cost reductions for payers. Trial registration Not applicable.

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“…For instance, poor antidepressant adherence has been associated with poor HbA1c control in subjects with diabetes. 35 Conversely, it could be expected that subjects with poor metabolic control and poor adherence to medical treatments are also at increased risk of poor antidepressant adherence.…”

Section: Factors Influencing Antidepressant Adherencementioning

confidence: 99%

How can we improve antidepressant adherence in the management of depression? A targeted review and 10 clinical recommendations

Solmi

Miola

Croatto

et al. 2021

Braz. J. Psychiatry

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Adherence to antidepressants is crucial for optimal treatment outcomes when treating depressive disorders. However, poor adherence is common among patients prescribed antidepressants. This targeted review summarizes the main factors associated with poor adherence, interventions that promote antidepressant adherence, pharmacological aspects related to antidepressant adherence, and formulates 10 clinical recommendations to optimize antidepressant adherence. Patient-related factors associated with antidepressant non-adherence include younger age, psychiatric and medical comorbidities, cognitive impairment, and substance use disorders. Prescriber behavior-related factors include neglecting medical and family histories, selecting poorly tolerated antidepressants, or complex antidepressant regimens. Multi-disciplinary interventions targeting both patient and prescriber, aimed at improving antidepressant adherence, include psychoeducation and providing the patient with clear behavioral interventions to prevent/minimize poor adherence. Regarding antidepressant choice, agents with individually tailored tolerability profile should be chosen. Ten clinical recommendations include four points focusing on the patient (therapeutic alliance, adequate history taking, measurement of depressive symptoms, and adverse effects improved access to clinical care), three focusing on prescribing practice (psychoeducation, individually tailored antidepressant choice, simplified regimen), two focusing on mental health services (improved access to mental health care, incentivized adherence promotion and monitoring), and one relating to adherence measurement (adherence measurement with scales and/or therapeutic drug monitoring).

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Impact of adherence to antidepressants on healthcare outcomes and costs among patients with type 2 diabetes and comorbid major depressive disorder

Abstract: Patients with better antidepressant adherence and adherence/persistence demonstrated better HbA1c control, with lower all-cause total and medical costs. Adherence, persistence, or adherence/persistence to antidepressants was associated with improved adherence to oral diabetes medications.

Cited by 11 publications

References 19 publications

Health care resource utilization and costs associated with nonadherence and nonpersistence to antidepressants in major depressive disorder

Health care resource utilization and costs associated with nonadherence and nonpersistence to antidepressants in major depressive disorder

Incremental burden of comorbid major depressive disorder in patients with type 2 diabetes or cardiovascular disease: a retrospective claims analysis

How can we improve antidepressant adherence in the management of depression? A targeted review and 10 clinical recommendations

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