McCombs J S, Nichol M B, Stimmel G L, Sclar D A, Beasley C M, Gross L S
University of Southern California School of Pharmacy, Los Angeles 90033.
J Clin Psychiatry. 1990 Jun;51 Suppl:60-9; discussion 70-1.
Paid claims data from the California Medicaid (Medi-Cal) program were used to examine the utilization of antidepressants and to estimate the costs of antidepressant treatment failure for patients with major depressive disorders (MDD). Data for 6713 new patient episodes of antidepressant therapy were available for the analysis; over 45% of these patients never achieved a minimum daily dose of antidepressants indicative of treatment for depression and were excluded from further analysis. That left a possible depression patient population of 3664 patients of which 2344 patients had a minimum of 1 full year of post-episode data for analysis. Only 81 patients (3.5%) displayed antidepressant use patterns consistent with the successful treatment of MDD; 296 patients (12.6%) displayed use patterns suggestive of antidepressant treatment failure. The remaining 1967 (84%) patients could not be clearly classified; they were either (1) patients being treated for problems other than MDD, (2) MDD patients who were being prescribed subtherapeutic doses by their physician due to side effects or other reasons, (3) MDD patients who were noncompliant for a variety of reasons, or (4) MDD patients who had prematurely terminated antidepressant therapy. Multivariate regression analysis was used to estimate the costs associated with MDD treatment failure. These analyses indicated that MDD treatment failure resulted in increased costs of approximately $1043 in the first post-episode year (p less than .10). These increased costs were primarily due to higher hospital costs ($921, p less than .05), while drug costs were reduced by $222 (p less than .001).
来自加利福尼亚医疗补助（医保）项目的付费理赔数据被用于研究抗抑郁药的使用情况，并估算重度抑郁症（MDD）患者抗抑郁治疗失败的成本。共有6713例新的抗抑郁治疗患者病例数据可供分析；其中超过45%的患者从未达到表明抑郁症治疗有效的最低每日抗抑郁药剂量，因此被排除在进一步分析之外。这样一来，可能的抑郁症患者群体为3664例，其中2344例患者有至少1整年的发作后数据可供分析。只有81例患者（3.5%）的抗抑郁药使用模式符合成功治疗MDD；296例患者（12.6%）的使用模式表明抗抑郁治疗失败。其余1967例（84%）患者无法明确分类；他们要么是（1）因MDD以外的问题接受治疗的患者，（2）因副作用或其他原因被医生开具低于治疗剂量药物的MDD患者，（3）因各种原因不依从治疗的MDD患者，要么是（4）过早终止抗抑郁治疗的MDD患者。采用多元回归分析来估算与MDD治疗失败相关的成本。这些分析表明，MDD治疗失败导致发作后第一年成本增加约1043美元（p<0.10）。这些成本增加主要是由于住院费用增加（921美元，p<0.05），而药物成本减少了222美元（p<0.001）。
