Analysis of Antidepressant Use Through Hierarchical Disease Analysis
- PDF / 183,687 Bytes
- 14 Pages / 504.57 x 720 pts Page_size
- 11 Downloads / 188 Views
Dis Manage Health Outcomes 2001; 9 (5): 255-267 1173-8790/01/0005-0255/$22.00/0 © Adis International Limited. All rights reserved.
Analysis of Antidepressant Use Through Hierarchical Disease Analysis Using a Managed Care Administrative Database Edward P. Armstrong Associate Professor, College of Pharmacy, University of Arizona, Tucson, Arizona, USA
Abstract
Objective: The purpose of this study was to evaluate the use of antidepressants through use of mutually exclusive disease indications using a managed care database. Design and setting: A claims database from a 225 000 member managed care organisation was used for the study. A hierarchy of mutually exclusive antidepressant indications was developed: ‘Depression’, ‘Other Approved Indication’, ‘Mental Health’, ‘Surrogate Diagnosis’, ‘Other Uses’, ‘Chronic Disease’, and a residual ‘Unclassified’ hierarchical indication group. Main outcome measures and results: Patients in the Depression and Other Approved Indication hierarchical groups likely received the antidepressant drugs primarily for these indications and frequently received selective serotonin reuptake inhibitors (SSRIs). Use of antidepressants in the Mental Health Disorders hierarchical group may have been for a related disease. The patients in the Surrogate Diagnosis, Other Uses, Chronic Diseases, and Unclassified hierarchical groups were significantly older than those patients in the Depression group and tricyclic antidepressant (TCA) use was more frequent than the SSRIs. The patients in the Unclassified diagnosis group may represent antidepressant use that is not adequately documented or not indicated. The Surrogate Diagnosis and Chronic Diseases hierarchical groups total healthcare costs were significantly higher than those observed in patients with a Depression diagnosis. Conclusions: Use of mutually exclusive hierarchical diagnosis groups proved to be a useful strategy for assessing antidepressant drug use. SSRI use was more common in the Depression and Other Approved Indication hierarchical groups. Patients in the Surrogate Diagnosis, Other Uses, Chronic Diseases, and Unclassified hierarchical groups used TCAs more frequently.
Depression is a common disease in the US. Its prevalence rate has been estimated to be between 5 to 10% and the 1990 total societal cost for depression was estimated to be over 30 billion US dollars ($US).[1] Overall, it is one of the 10 most costly illnesses in the US and is often undertreated.[2,3] Further, depression is a disease that is well known to
be purposely miscoded and is frequently underdiagnosed.[4] Antidepressants are a commonly prescribed class of medications. Recent research has compared the selective serotonin reuptake inhibitors (SSRIs) and the older tricyclic antidepressants (TCAs) and has shown that use of TCAs are associated with admin-
256
istration of subtherapeutic dosages and premature termination of therapy compared with the SSRIs.[5-7] Additional data have shown that TCAs are associated with more adverse events and lower compliance rates.[8] Wi
Data Loading...
