Thomson Reuters, Outcomes Research, Cambridge, MA, USA.
J Med Econ. 2012;15(4):672-80. doi: 10.3111/13696998.2012.672941. Epub 2012 Mar 20.
Duloxetine is indicated for treatment of major depressive disorders in the UK. While clinical trials have documented its clinical effectiveness, little is known regarding the relationship between duloxetine use and healthcare utilization in community practice. This study quantifies the impact of treatment with duloxetine on healthcare utilization among patients with depression and those with depression and co-existing pain.
Depressed adults initiating duloxetine during 1/1/2006-9/30/2007 were identified from the General Practice Research Database (GPRD). All-cause hospitalization, accident/emergency visits, specialist referrals, and analgesic use in the 12 months before (pre-period) and after (post-period) duloxetine initiation were compared. Generalized Estimating Equation models evaluated the pre-post change in the odds of hospitalization.
Nine hundred and nine patients were identified, 413 had pre-period unexplained pain (UPain). Rates of hospitalization declined from the pre- to the post-period. Fewer UPain patients received analgesics post-duloxetine initiation. Multivariate analyses confirmed that the odds of hospitalization were lower after duloxetine initiation. UPain patients with pre-period anticonvulsant use had lower odds of hospitalization in the post-period and the reduction in odds was significantly larger than that of patients without pre-period anticonvulsants. While patients with pre-period anxiolytic use, alcohol/drug dependence, or sleep disorders did not show statistically significant pre-post change in the odds of hospitalization, these changes were significantly different from patients without these conditions.
The study did not include a comparison group of patients who were non-users of duloxetine. Prevalence of chronic conditions might be under-estimated due to coding in the GPRD. Medications were assumed to be taken as prescribed. Study results are not generalizable beyond the population covered by the UK's primary care system.
All-cause hospitalization rates lowered among depressed patients and fewer UPain patients received analgesics post-duloxetine initiation. The reduction in the odds of hospitalization was most pronounced among UPain patients receiving pre-period anticonvulsants.
度洛西汀在英国被批准用于治疗重度抑郁症。虽然临床试验已经证明了其临床疗效，但对于度洛西汀在社区实践中的应用与医疗保健利用之间的关系知之甚少。本研究定量评估了度洛西汀治疗对伴有或不伴有疼痛的抑郁症患者的医疗保健利用的影响。
从普通实践研究数据库（GPRD）中确定了在 2006 年 1 月 1 日至 2007 年 9 月 30 日期间开始使用度洛西汀的成年抑郁症患者。比较了在度洛西汀使用前（前周期）和后（后周期）12 个月期间的全因住院、事故/急诊就诊、专科转介和镇痛药使用情况。采用广义估计方程模型评估了住院的可能性在前后周期的变化。
确定了 909 名患者，其中 413 名患者在前周期有未明确的疼痛（UPain）。住院率从前周期到后周期下降。在开始使用度洛西汀后，较少的 UPain 患者使用镇痛药。多变量分析证实，度洛西汀治疗后，住院的可能性降低。在前周期使用抗惊厥药的 UPain 患者在后周期的住院可能性降低，且降低的幅度明显大于未在前周期使用抗惊厥药的患者。尽管在前周期使用抗焦虑药、酒精/药物依赖或睡眠障碍的患者在住院可能性方面没有表现出统计学上的前后变化，但这些变化与没有这些情况的患者有显著不同。
该研究没有包括非度洛西汀使用者的对照组。由于 GPRD 中的编码，慢性疾病的患病率可能被低估。假设药物是按照规定服用的。研究结果不能推广到英国初级保健系统涵盖的人群之外。
在抑郁症患者中，全因住院率降低，并且在开始使用度洛西汀后，较少的 UPain 患者使用镇痛药。在接受前周期抗惊厥药治疗的 UPain 患者中，住院可能性的降低最为明显。
