Sheehan David V, Eaddy Michael T, Shah Manan B, Mauch Robert P
Department of Psychiatry and Behavioral Medicine, University of South Florida, 4202 E. Fowler Avenue, Tampa, FL 33620, USA.
Am J Manag Care. 2005 Oct;11(12 Suppl):S354-61.
There is growing evidence that adherence to the recommended duration of antidepressant therapy results in reduced medical costs compared with nonadherence, and that the likelihood of adhering to therapy is not equivalent across the selective serotonin reuptake inhibitors (SSRIs). As such, the purpose of this study was to assess differences in 6-month medical costs between paroxetine controlled-release (CR) and immediate-release (IR) SSRI agents in a retrospective analysis of patients initiating SSRI therapy identified from the Integrated Healthcare Information Services National Managed Care Benchmark Database during a 2.5-year time frame. Inferential analyses were performed to evaluate differences in 6-month medical costs, controlling for differences in age, sex, utilization of psychiatric specialty care services, titration, pre-period costs, and comorbidity measures. Of the 146 075 patients included in this study, approximately 7% received paroxetine CR. Approximately 29.5% of patients had an anxiety disorder diagnosis; 26.0% had a depression-only diagnosis; and 13.2% had comorbid anxiety and depression. The 6-month medical costs were 244 US dollars lower for patients initiating with paroxetine CR compared with the average medical costs for patients receiving IR SSRIs. Paroxetine CR also had the lowest medical costs compared with each individual SSRI evaluated. After log transformation of costs and adjustment for baseline covariates, the aggregated IR SSRIs were associated with 8.7% higher 6-month medical costs than paroxetine CR (P <.001) and even greater costs after stratifying by diagnosis: 12.5% higher costs in patients with anxiety, 14.3% higher costs in patients with depression, and 15.9% higher costs in patients with comorbid anxiety and depression (P <.001 for all). Each individual IR SSRI was also associated with significantly higher medical costs than paroxetine CR, irrespective of diagnosis. As demonstrated, medical costs over a 6-month time frame were significantly greater for IR SSRIs versus paroxetine CR, even after adjusting for background characteristics and stratifying by diagnosis. Future studies should measure rates of adherence in relation to medical outcomes over an expanded time frame.
越来越多的证据表明，与不坚持治疗相比，坚持推荐的抗抑郁治疗疗程可降低医疗成本，而且在选择性5-羟色胺再摄取抑制剂（SSRI）中，坚持治疗的可能性并不相同。因此，本研究的目的是在一项回顾性分析中，评估从综合医疗信息服务全国管理式医疗基准数据库中识别出的、在2.5年时间范围内开始接受SSRI治疗的患者中，帕罗西汀控释（CR）制剂和速释（IR）制剂在6个月医疗成本上的差异。进行了推断性分析，以评估6个月医疗成本的差异，并控制年龄、性别、精神科专科护理服务的使用、滴定、前期成本和合并症指标的差异。在本研究纳入的146075例患者中，约7%接受了帕罗西汀CR制剂治疗。约29.5%的患者被诊断患有焦虑症；26.0%的患者仅被诊断患有抑郁症；13.2%的患者同时患有焦虑症和抑郁症。与接受IR SSRI制剂治疗的患者的平均医疗成本相比，开始使用帕罗西汀CR制剂治疗的患者6个月医疗成本低244美元。与所评估的每种单独的SSRI制剂相比，帕罗西汀CR制剂的医疗成本也最低。在对成本进行对数转换并对基线协变量进行调整后，汇总的IR SSRI制剂与6个月医疗成本比帕罗西汀CR制剂高8.7%相关（P<.001），按诊断分层后成本更高：焦虑症患者成本高12.5%，抑郁症患者成本高14.3%，同时患有焦虑症和抑郁症的患者成本高15.9%（所有P值均<.001）。无论诊断如何，每种单独的IR SSRI制剂与帕罗西汀CR制剂相比，医疗成本也显著更高。如所示，即使在调整背景特征并按诊断分层后，IR SSRI制剂在6个月时间范围内的医疗成本仍显著高于帕罗西汀CR制剂。未来的研究应在更长的时间范围内衡量与医疗结果相关的坚持治疗率。
