Lundbeck SAS, Global Outcome Research, Issy-Les-Moulineaux, France.
Value Health. 2013 Dec;16(8):1133-9. doi: 10.1016/j.jval.2013.09.001. Epub 2013 Oct 20.
To describe real-life prescription patterns, health care resource use, and costs in adults with generalized anxiety disorder (GAD) initiating antidepressant (AD) treatment in the United Kingdom.
A retrospective longitudinal cohort study using data from Clinical Research Practice Datalink was conducted. Adults with incident prescription of an AD (index date) between January 1, 2006, and June 30, 2010, and with a diagnosis of GAD within the 2 months preceding or following the index date were included. Patients with a diagnosis of schizophrenia or bipolar disorder were excluded.
A total of 29,131 patients with GAD were included in the analysis. Their mean age was 48.5 ± 15.5 years, and two thirds were women. GAD-licensed ADs (i.e., escitalopram, paroxetine, venlafaxine XR, and duloxetine) represented only 12.5% of the index AD prescriptions. At least one anxiolytic was prescribed for 23.5% of the patients. Only 33.2% of the patients continued index AD treatment over the study period. Discontinuation occurred for 46.0% of the patients, after a mean of 3.7 months of treatment. The health care costs were £338.4 per patient in the 6 months before the index date and £984.6 in the 9 months after the index date. Psychiatric hospitalization (relative risk = 4.18; 95% CI 3.53-4.96; P < 0.001) and duloxetine as index treatment (relative risk = 1.85; 95% CI 1.30-2.63; P < 0.001) were the main determinants of increased costs for these patients.
The significant rate of AD discontinuation and associated treatment duration indicate unmet needs among patients with GAD. As described in American studies, substantial health care costs were also observed in this study.
描述英国广泛性焦虑障碍（GAD）成人患者在开始使用抗抑郁药（AD）治疗时的实际处方模式、医疗资源利用情况和成本。
采用临床研究实践数据链接中的回顾性纵向队列研究。纳入 2006 年 1 月 1 日至 2010 年 6 月 30 日期间首次处方 AD（索引日期）且在索引日期前或后 2 个月内诊断为 GAD 的成人患者。排除诊断为精神分裂症或双相情感障碍的患者。
共纳入 29131 例 GAD 患者。他们的平均年龄为 48.5±15.5 岁，三分之二为女性。GAD 许可的 AD（即依他普仑、帕罗西汀、文拉法辛 XR 和度洛西汀）仅占索引 AD 处方的 12.5%。有 23.5%的患者同时开具了至少一种抗焦虑药物。在研究期间，只有 33.2%的患者继续使用索引 AD 治疗。有 46.0%的患者在平均 3.7 个月的治疗后停止了治疗。在索引日期前的 6 个月内，每位患者的医疗费用为 338.4 英镑，在索引日期后的 9 个月内为 984.6 英镑。精神病住院治疗（相对风险=4.18；95%置信区间 3.53-4.96；P<0.001）和度洛西汀作为索引治疗（相对风险=1.85；95%置信区间 1.30-2.63；P<0.001）是这些患者费用增加的主要决定因素。
AD 停药率高且治疗持续时间长，表明 GAD 患者存在未满足的需求。与美国的研究描述一致，本研究也观察到了大量的医疗保健费用。
