A pharmacoeconomic study of the management of major depression: patients in a TennCare HMO.

The purpose of this study was to evaluate the direct medical costs of treating patients diagnosed with major depression in a TennCare managed care setting. This retrospective analysis was conducted on paid-claims data (including a 10-month lag) from January through December 1994 for patients who met criteria for major depressive disorder and were receiving tricyclic antidepressants (TCAs) or selective serotonin-reuptake inhibitors (SSRIs), for at least three consecutive months. Expenditures measured included office visits, hospital charges, emergency room charges, and drug costs. A total of 976 HMO beneficiaries were identified, and 76 randomly selected patients who were receiving TCAs were compared with 76 randomly selected patients who were receiving SSRIs to evaluate total cost of therapy associated with these two classes of antidepressants. The results of this analysis indicate that the total cost of treatment for Medicaid patients suffering major depression is similar between these two classes of antidepressants. Also, among the three SSRIs, the average daily dose was lowest for paroxetine (21.1 mg/day) and highest with sertraline (81.3 mg/day) and concomitant antidepressant therapy highest with fluoxetine (7.4%).