Stein Murray B, Cantrell Christopher Ron, Sokol Michael C, Eaddy Michael T, Shah Manan B
Department of Psychiatry and family and preventive medicine at the University of California, La Jolla, California 92093-0985, USA.
Psychiatr Serv. 2006 May;57(5):673-80. doi: 10.1176/ps.2006.57.5.673.
This study evaluated adherence with selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) among patients who newly initiated therapy for anxiety with or without comorbid depression; the study also quantified the health-related economic consequences of nonadherence.
A large managed care database was used to gather retrospective data for patients with anxiety disorders who had a prescription for an antidepressant between July 1, 2001, and December 31, 2002. The relationship between antidepressant adherence and medical resource utilization was assessed; the analysis controlled for age, gender, utilization of mental health specialty care, change in medication, whether the dosage was titrated, costs in the six months before the prescription for an antidepressant, and comorbid physical conditions.
Of the 13,085 patients with anxiety diagnoses who met the criteria for study inclusion, 57 percent were nonadherent to antidepressant therapy at six months. Patients who received mental health specialty care were more likely than those who did not receive such care to be adherent to therapy (48.5 percent compared with 40.7 percent; p<.001). Those with dual diagnoses of anxiety and depression were more likely than those with anxiety alone to be adherent to therapy (46.8 percent compared with 40.2 percent; p<.001). Those with a coded diagnosis of posttraumatic stress disorder had the highest medical costs. Patients with anxiety and depression had significantly higher total costs than patients with anxiety alone. Adherent patients who did not have a change in medication or a titrated dosage had significantly lower medical costs than nonadherent patients; however, total costs (medical plus pharmacy) were similar.
Nonadherence with antidepressant therapy in anxiety disorders is common, but mental health specialty care may be associated with improved adherence. Lower medical costs for adherent patients who did not have a change in medication or a titrated dosage offset the increase in pharmacy costs, resulting in total costs (medical plus pharmacy) that were similar to those of nonadherent patients.
本研究评估了新开始接受抗焦虑治疗（伴或不伴有合并抑郁症）的患者对选择性5-羟色胺再摄取抑制剂（SSRIs）或5-羟色胺-去甲肾上腺素再摄取抑制剂（SNRIs）的依从性；该研究还对不依从治疗所导致的与健康相关的经济后果进行了量化。
利用一个大型管理式医疗数据库收集2001年7月1日至2002年12月31日期间有抗抑郁药处方的焦虑症患者的回顾性数据。评估了抗抑郁药依从性与医疗资源利用之间的关系；分析时控制了年龄、性别、精神科专科护理的利用情况、药物变化、剂量是否滴定、抗抑郁药处方前六个月的费用以及合并的身体状况。
在符合研究纳入标准的13085例焦虑症诊断患者中，57%在六个月时未坚持抗抑郁治疗。接受精神科专科护理的患者比未接受此类护理的患者更有可能坚持治疗（48.5%对40.7%；p<0.001）。同时患有焦虑症和抑郁症的患者比仅患有焦虑症的患者更有可能坚持治疗（46.8%对40.2%；p<0.001）。有创伤后应激障碍编码诊断的患者医疗费用最高。患有焦虑症和抑郁症的患者的总费用显著高于仅患有焦虑症的患者。未改变药物或未滴定剂量的依从性患者的医疗费用显著低于不依从患者；然而，总费用（医疗加药房）相似。
焦虑症患者不坚持抗抑郁治疗很常见，但精神科专科护理可能与依从性提高有关。未改变药物或未滴定剂量的依从性患者较低的医疗费用抵消了药房费用的增加，导致总费用（医疗加药房）与不依从患者相似。
