Endicott Jean, McLaughlin Trent P, Grudzinski Amy N
New York State Psychiatric Institute, New York, NY, USA.
J Clin Psychiatry. 2003 Dec;64(12):1511-6. doi: 10.4088/jcp.v64n1216.
To determine the impact on managed care charges of selecting citalopram, fluoxetine, paroxetine, or sertraline as first-line pharmacotherapy for newly diagnosed premenstrual dysphoric disorder (PMDD).
This retrospective study analyzed administrative claims data from 14 managed care plans in the United States. The study population was identified from an integrated outcomes database for the period Jan. 1, 1998, to Dec. 31, 1999. Patients aged 18 years or older, newly diagnosed with PMDD, and initiating therapy with a selective serotonin reuptake inhibitor (SSRI) within 30 days of the diagnosis were eligible for analysis. To date, there is no specific ICD-9 diagnosis code for PMDD; thus, patients were required to have an ICD-9 diagnosis of premenstrual tension syndrome (ICD-9 625.4). Patients with documented previous psychiatric disorders/treatment were excluded. All inpatient, outpatient, and pharmacy claims incurred by each patient during the study period were included in the analysis. PMDD-related treatment charges for the 6-month period following treatment initiation were compared using multivariate regression.
A total of 1413 patients met the study criteria. Fluoxetine and sertraline were the most common agents selected as first-line therapy. After differences in age, managed care plan, pretreatment resource utilization, physician specialty, index prescription year, treatment charges, presence of mental health and nonmental health comorbid conditions, and changes in medication were controlled for, patients taking paroxetine and citalopram had significantly higher PMDD-related treatment charges than sertraline patients (paroxetine, p =.0430; citalopram, p =.0226). Fluoxetine patients also had higher treatment charges than sertraline patients, though statistical significance was not reached.
Sertraline, as first-line therapy for PMDD, was associated with lower PMDD-related treatment charges compared with other SSRIs during the first 6 months after treatment initiation.
确定选择西酞普兰、氟西汀、帕罗西汀或舍曲林作为新诊断的经前烦躁障碍（PMDD）的一线药物治疗对管理式医疗费用的影响。
这项回顾性研究分析了来自美国14个管理式医疗计划的行政索赔数据。研究人群从1998年1月1日至1999年12月31日的综合结果数据库中确定。年龄在18岁及以上、新诊断为PMDD且在诊断后30天内开始使用选择性5-羟色胺再摄取抑制剂（SSRI）治疗的患者符合分析条件。迄今为止，尚无PMDD的特定ICD-9诊断代码；因此，患者必须有经前紧张综合征的ICD-9诊断（ICD-9 625.4）。有既往精神疾病/治疗记录的患者被排除。分析包括每位患者在研究期间产生的所有住院、门诊和药房索赔。使用多变量回归比较治疗开始后6个月期间与PMDD相关的治疗费用。
共有1413名患者符合研究标准。氟西汀和舍曲林是最常被选为一线治疗的药物。在控制了年龄、管理式医疗计划、治疗前资源利用、医生专业、索引处方年份、治疗费用、心理健康和非心理健康合并症的存在以及药物变化的差异后，服用帕罗西汀和西酞普兰的患者与PMDD相关的治疗费用显著高于服用舍曲林的患者（帕罗西汀，p = 0.0430；西酞普兰，p = 0.0226）。氟西汀患者的治疗费用也高于舍曲林患者，尽管未达到统计学显著性。
与其他SSRI相比，舍曲林作为PMDD的一线治疗药物，在治疗开始后的前6个月与较低的PMDD相关治疗费用相关。
