Economic Outcomes of Switching Treatment in Major Depressive Disorder Patients
Objectives: To evaluate the economic consequences associated with switching major depressive disorder (MDD) patients from a generic selective serotonin reuptake inhibitor (SSRI) treatment to escitalopram, venlafaxine/duloxetine, or another generic SSRI.
Study Design: Adult MDD patients treated with a generic SSRI, identifi ed in the Ingenix Impact database, were included if they were switched to escitalopram, venlafaxine/duloxetine, or another generic SSRI.
Methods: Urgent care utilization during the 3-month follow-up period and costs incurred during the 3 months before and after the switching date were compared both descriptively and using multivariate regression analyses.
Results: The study identifi ed 7774 patients switched to escitalopram, 10,505 to venlafaxine/duloxetine, and 6723 to another generic SSRI. Compared with escitalopram switchers, venlafaxine/ duloxetine switchers had an increased adjusted risk of any-cause, mental health–related, and MDD-related urgent care utilization (odds ratio [OR] = 1.10, 1.30, and 1.36, respectively; all P <.05). Patients who were switched to a generic SSRI experienced increased adjusted risk of mental health–related urgent care utilization (OR =1.17, P = .0319). Compared with switchers to another generic SSRI, medical costs were signifi cantly reduced for switchers to escitalopram (–$402) or venlafaxine/duloxetine (–$254; both P <.05). Escitalopram switchers had relative savings of $383 (P = .016) and $172 (P = .276) compared with venlafaxine/duloxetine switchers and generic SSRI switchers, respectively.
Conclusions: Switching from generic SSRI therapy to escitalopram appears to be a more effective strategy in MDD than switching to venlafaxine/duloxetine and at least as cost-effective as switching to another generic SSRI therapy.
(Am J Pharm Benefi ts. 2011;3(6):e111-e120)
Study Design: Adult MDD patients treated with a generic SSRI, identifi ed in the Ingenix Impact database, were included if they were switched to escitalopram, venlafaxine/duloxetine, or another generic SSRI.
Methods: Urgent care utilization during the 3-month follow-up period and costs incurred during the 3 months before and after the switching date were compared both descriptively and using multivariate regression analyses.
Results: The study identifi ed 7774 patients switched to escitalopram, 10,505 to venlafaxine/duloxetine, and 6723 to another generic SSRI. Compared with escitalopram switchers, venlafaxine/ duloxetine switchers had an increased adjusted risk of any-cause, mental health–related, and MDD-related urgent care utilization (odds ratio [OR] = 1.10, 1.30, and 1.36, respectively; all P <.05). Patients who were switched to a generic SSRI experienced increased adjusted risk of mental health–related urgent care utilization (OR =1.17, P = .0319). Compared with switchers to another generic SSRI, medical costs were signifi cantly reduced for switchers to escitalopram (–$402) or venlafaxine/duloxetine (–$254; both P <.05). Escitalopram switchers had relative savings of $383 (P = .016) and $172 (P = .276) compared with venlafaxine/duloxetine switchers and generic SSRI switchers, respectively.
Conclusions: Switching from generic SSRI therapy to escitalopram appears to be a more effective strategy in MDD than switching to venlafaxine/duloxetine and at least as cost-effective as switching to another generic SSRI therapy.
(Am J Pharm Benefi ts. 2011;3(6):e111-e120)
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