Gauthier Geneviève, Guérin Annie, Zhdanava Maryia, Jacobson William, Nomikos George, Merikle Elizabeth, François Clément, Perez Vanessa
Analysis Group, Inc., Montreal, QC, Canada.
Takeda Development Center Americas, Inc., One Takeda Parkway, Deerfield, IL, 60015, USA.
BMC Psychiatry. 2017 Jun 19;17(1):222. doi: 10.1186/s12888-017-1385-0.
Although the symptoms of major depressive disorder (MDD) are often manageable with pharmacotherapy, response to first-line antidepressant treatment is often less than optimal. This study describes long-term treatment patterns in MDD patients in the United States and quantifies the economic burden associated with different treatment patterns following first-line antidepressant therapy.
MDD patients starting first-line antidepressant monotherapy and having continuous enrollment ≥12 months before and ≥24 months following the index date (i.e., the first documented prescription fill) were selected from the Truven Health Analytics MarketScan (2003-2014) database. Based on the type of first treatment change following initiation, six treatment cohorts were defined a priori ("persistence"; "discontinuation"; "switch"; "dose escalation"; "augmentation"; and "combination"). Treatment patterns through the fourth line of therapy within each cohort, healthcare resource utilization (HCRU), and cost analyses were restricted to patients with adequate treatment duration (defined as ≥42 days) in each line (analysis sub-sample, N = 21,088). HCRU and costs were described at the cohort and pattern levels. Treatment cohorts representing <5% of the analysis sub-sample were decided a priori not to be analyzed due to limited sample size.
39,557 patients were included. Mean age was 42.1 years, 61.1% of patients were female, and mean follow-up was 4.1 years. Among the analysis sub-sample, the discontinuation (49.1%), dose escalation (37.4%), and switch (6.6%) cohorts were the most common of all treatment cohorts. First-line antidepressant discontinuation without subsequent MDD pharmacotherapy (22.9%) and cycling between discontinuation and resumption (11.2%) were the two most common treatment patterns. Median time to discontinuation was 23 weeks. The switch cohort exhibited the highest HCRU (18.9 days with medical visits per-patient-per-year) and greatest healthcare costs ($11,107 per-patient-per-year) following the index date. Treatment patterns representing a cycling on and off treatment in the switch cohort were associated with the greatest healthcare costs overall.
A high proportion of patients discontinue first-line antidepressant shortly after initiation. Patterns representing a cycling on and off treatment in the switch cohort were associated with the highest healthcare costs. These findings underscore challenges in effectively treating patients with MDD and a need for personalized patient management.
尽管重度抑郁症（MDD）的症状通常可以通过药物治疗得到控制，但一线抗抑郁治疗的反应往往不尽人意。本研究描述了美国MDD患者的长期治疗模式，并量化了一线抗抑郁治疗后不同治疗模式相关的经济负担。
从Truven Health Analytics MarketScan（2003 - 2014）数据库中选取开始一线抗抑郁单药治疗且在索引日期（即首次有记录的处方配药）前连续入组≥12个月且索引日期后≥24个月的MDD患者。根据起始后首次治疗变化的类型，预先定义了六个治疗队列（“持续治疗”；“停药”；“换药”；“剂量增加”；“增效”；“联合用药”）。每个队列中直至第四线治疗的治疗模式、医疗资源利用（HCRU）以及成本分析仅限于每行治疗持续时间足够（定义为≥42天）的患者（分析子样本，N = 21,088）。HCRU和成本在队列和模式层面进行描述。由于样本量有限，预先决定对占分析子样本<5%的治疗队列不进行分析。
纳入39,557例患者。平均年龄为42.1岁，61.1%的患者为女性，平均随访时间为4.1年。在分析子样本中，停药队列（49.1%）、剂量增加队列（37.4%）和换药队列（6.6%）是所有治疗队列中最常见的。一线抗抑郁药停药后未进行后续MDD药物治疗（22.9%）以及在停药和恢复用药之间循环（11.2%）是两种最常见的治疗模式。停药的中位时间为23周。索引日期后，换药队列的HCRU最高（每位患者每年有18.9天进行医疗就诊）且医疗成本最高（每位患者每年11,107美元）。换药队列中代表治疗循环开启和关闭的治疗模式总体上与最高的医疗成本相关。
很大一部分患者在开始一线抗抑郁药治疗后不久就停药。换药队列中代表治疗循环开启和关闭的模式与最高的医疗成本相关。这些发现凸显了有效治疗MDD患者的挑战以及个性化患者管理的必要性。
