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.
Journal: 2019/October - Journal of Medical Economics
ISSN: 1941-837X
Abstract:
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.
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