Determinants of Direct Cost Differences among US Employees with Major Depressive Disorders Using Antidepressants
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Pharmacoeconomics 2009; 27 (6): 507-517 1170-7690/09/0006-0507/$49.95/0
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Determinants of Direct Cost Differences among US Employees with Major Depressive Disorders Using Antidepressants Howard G. Birnbaum,1 Rym Ben-Hamadi,1 Paul E. Greenberg,1 Matthew Hsieh,1 Jackson Tang1 and Camille Reygrobellet2 1 Analysis Group, Inc., Boston, Massachusetts, USA 2 sanofi-aventis, Paris, France
Abstract
Objective: To understand factors driving the economic burden of major depressive disorder (MDD) patients with different treatment regimens, by evaluating the relationship between medical profiles and treatment costs. Methods: Claims data for US privately insured employees (1999–2004) were analysed. Analysis included adult employees with ‡1 diagnosis of MDD and ‡1 prescription for specific antidepressants following a 6-month washout period. Patients were first classified into treatment pattern groups (switchers/discontinuers/maintainers/augmenters), then stratified into mutually exclusive treatment groups – nonstable, stable and intermediate – based on evidence of stability in treatment therapy. Rates of mental and physical co-morbidities, injuries/accidents, substance abuse and urgent care use were analysed across treatment pattern groups. Direct (medical/drug) costs were calculated per patient per year and disaggregated into depression- and nondepression-related components. A two-part multivariate model controlled for baseline characteristics. Costs were also estimated for patients with MDD only, patients with MDD and generalized anxiety disorder (GAD), and patients with MDD and any type of anxiety. Results: Annual per patient adjusted costs (year 2005 values) were significantly lower among stable patients ($US6215) than among intermediate ($US7317) and nonstable patients ($US9948; p < 0.001). Stable patients also had lower depression- and non-depression-related costs. Patients with MDD and comorbid GAD or any type of anxiety had significantly higher costs than MDD-only patients. Conclusions: Nonstability of treatment is associated with higher comorbidity rates, more urgent care use and higher total, depression- and non-depressionrelated direct costs. The stable group represents continuity of care and is associated with significant cost savings. Co-morbidities are associated with increased costs.
Birnbaum et al.
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Background Major depressive disorder (MDD) affected 18.1 million people in 2000 in the US and had a lifetime prevalence of 16.2%.[1,2] Cost-of-illness studies indicate that MDD is associated with a substantial economic burden.[3,4] The prevalence of the disease, the treatment rate and rate and degree of impairment contribute to the substantial economic burden of depression involved in treatment of the disease itself and its accompanying co-morbidities.[1,5] Depression can also have an impact on the labour market and was shown to be significantly associated with retirement among US workers.[6] The literature on the economic consequences of treatment failure f
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