Pharmacy and Medical Costs Associated With Switching Between Venlafaxine and SSRI Antidepressant Therapy for the Treatment of Major Depressive Disorder

Abstract

BACKGROUND: While much has been published on utilization of anti depressants and associated resource use, surprisingly little information is available on the relationship between a change in antidepressant agent and health care utilization. Given that many patients will not respond to initial therapy (and therefore would be candidates for switching treatment) and the array of antidepressant medications on the market, information on the impact of switching would be beneficial to both providers and policymakers.OBJECTIVE: To explore patterns of antidepressant drug use and depression related and allcause medical costs for patients who switched therapy between 2 drug classes, selective serotonin reuptake inhibitors (SSRIs) and the selective norepinephrine reuptake inhibitor (SNRI) venlafaxine.METHODS: Using an administrative claims database of 36 million members from 61 health plans, this retrospective cohort analysis examined patients who had (1) a diagnosis of major depressive disorder (MDD, International Classification of Diseases, Ninth Revision, Clinical Modification [ICD9CM] code 296.2x for MDD single episode, 296.3x for MDD recurrent episode, 300.4 for dysthymic disorder, and 311 for depressive disorder not else where classified) and (2) a newly prescribed antidepressant during the year 2002. Costs were defined as amounts paid by health plans for all inpatient, outpatient, physician and pharmacy services (i.e., allowed charges after subtraction of member costshare). Depressionrelated costs were defined using (1) medical claims with primary diagnosis of depression and (2) pharmacy claims for antidepressants. Using an index date of the first antidepressant claim, 12 months of preindex and post index data were available for all eligible patients. Switching was defined as occurring between the SSRIs and venlafaxine (i.e., patients who switched within the SSRI drug class across different SSRIs were treated as non switchers until they switched to venlafaxine), and there was no minimum or maximum gap in therapy. The SSRIs included fluoxetine, citalopram, sertraline, and paroxetine; the only SNRI on the market at the time was venlafaxine. Multivariate regression analyses determined predictors of switching and factors influencing overall and depressionrelated costs, while controlling for confounding factors. For the 12month period following the index date (fixed length of followup), the study compared perpatient peryear (PPPY) costs for (1) patients who switched versus those who did not switch and (2) patients with single versus multiple trials of SSRI for the subgroup of patients who switched from an SSRI to venlafaxine. For the time periods before versus after the switch (variable lengths of followup), perpatient means and medians of monthly cost averages (with followup periods < 1 month set to 1 month for 16.5% After adjustment for multiple covariates including demographic characteristics, 10 selected comorbidities, and physician specialty, general linear models with log transformed costs as the dependent...

Pharmacotherapeutic strategies for patients treated for depression in UK primary care: a database analysis

“…Interestingly, switching or other medication changes appeared to incur greater use of healthcare resources than resumption of monotherapy. This is similar to the findings of previous database studies in patients with depression, which noted that switching or combining antidepressants was associated with greater all-cause resource use and costs than maintenance of therapy 33,48 .…”

Update in the methodology of the chronic stress paradigm: internal control matters

“…Depression as a major health issue is illustrated by its death-toll, which currently claims more lives per year than road-traffic accidents [1-4]. At the same time, there is an obvious need for an improvement in the treatment of depression, as up to 45% of depressed patients do not show improved mood after advanced therapy and 15% of patients do not respond to any antidepressant therapies [5].…”

Switching Antidepressant Drug Therapy Helps Some Patients Some of the Time--What TORDIA, STAR*D, and Observational Research Have Taught Us About Treatment-Resistant Depression

“…2 The high failure rate for antidepressant therapy in realworld settings is not surprising and poses an important challenge in treatment management. As Curtiss observed previously in JMCP, (a) antidepressant drug therapy alone is not much more effective than placebo, and the difference between antidepressant drug and placebo varies among clinical trials, with the effect of the active drug larger in patients with more severe depression, and (b) drug therapy is about as effective as psychotherapy, generally described as cognitive behavioral therapy (CBT).…”