Partnership for Health Analytic Research (PHAR), LLC, 280 S. Beverly Dr., Beverly Hills, CA, 90212, USA.
Otsuka Pharmaceutical Development and Commercialization, Inc., 508 Carnegie Center, Princeton, NJ, 08540, USA.
Adv Ther. 2018 Dec;35(12):2138-2151. doi: 10.1007/s12325-018-0838-2. Epub 2018 Nov 19.
There is little evidence regarding the most effective timing of augmentation of antidepressants (AD) with antipsychotics (AP) in patients with major depressive disorder (MDD) who inadequately respond to first-line AD (inadequate responders). The study's objective was to understand the association between timing of augmentation of AD with AP and overall healthcare costs in inadequate responders.
Using the Truven Health MarketScan Medicaid, Commercial, and Medicare Supplemental databases (7/1/09-12/31/16), we identified adult inadequate responders if they had one of the following indicating incomplete response to initial AD: psychiatric hospitalization or emergency department (ED) visit, initiating psychotherapy, or switching to or adding on a different AD. Two mutually exclusive cohorts were identified on the basis of time from first qualifying event date to first date of augmentation with an AP (index date): 0-6 months (early add-on) and 7-12 months (late add-on). Patients were further required to be continuously enrolled 1 year before (baseline) and 1 year after (follow-up) index date. Patients with schizophrenia or bipolar disorder diagnoses were excluded. General linear regression was used to estimate adjusted healthcare costs in the early versus late add-on cohort, controlling for baseline demographic and clinical characteristics, insurance type, medications, and ED visits or hospitalizations.
Of the 6935 identified inadequate responders, 68.7% started an AP early and 31.3% late. At baseline, before AP augmentation, patients in the early add-on cohort had higher psychiatric comorbid disease burden (47.3% vs. 42.5%; p < 0.001) and higher inpatient utilization [mean (SD) 0.41 (0.72) vs. 0.27 (0.67); p < 0.001] than in late add-on cohort. During follow-up, the adjusted total all-cause healthcare cost was significantly lower in the early vs. late add-on cohort ($18,864 vs. $20,452; p = 0.046).
Findings of this real-world study suggest that, in patients with MDD who inadequately responded to first-line AD treatment, adding an AP earlier reduces overall healthcare costs.
Otsuka Pharmaceutical Development and Commercialization, Inc. and Lundbeck.
在一线抗抑郁药（AD）治疗反应不足的重度抑郁症（MDD）患者中，加用抗精神病药（AP）的最佳时机证据有限。本研究的目的是了解 AD 加用 AP 的时机与反应不足者的整体医疗保健成本之间的关联。
使用 Truven Health MarketScan Medicaid、商业和 Medicare 补充数据库（2009 年 7 月 1 日-2016 年 12 月 31 日），如果患者出现以下任何一种情况，我们将其确定为初始 AD 治疗不完全反应的不足反应者：精神科住院或急诊就诊、开始心理治疗、或转用或加用另一种 AD：精神病住院或急诊就诊、开始心理治疗、或转用或加用另一种 AD。根据从首次符合条件的事件日期到首次加用 AP 的日期（索引日期）的时间，确定了两个相互排斥的队列：0-6 个月（早期加用）和 7-12 个月（晚期加用）。患者还需要在索引日期之前和之后连续 1 年（基线和随访）入组。排除诊断为精神分裂症或双相情感障碍的患者。采用普通线性回归估计早期与晚期加用组的调整后医疗保健费用，控制基线人口统计学和临床特征、保险类型、药物和急诊就诊或住院治疗。
在确定的 6935 名反应不足的患者中，68.7%的患者早期开始使用 AP，31.3%的患者晚期开始使用 AP。在基线时，在 AP 加用之前，早期加用组的患者精神共病疾病负担更高（47.3%比 42.5%；p<0.001），住院利用率更高[平均（SD）0.41（0.72）比 0.27（0.67）；p<0.001]。在随访期间，早期与晚期加用组的调整后总全因医疗保健费用差异有统计学意义（18864 美元比 20452 美元；p=0.046）。
这项真实世界研究的结果表明，在一线 AD 治疗反应不足的 MDD 患者中，早期加用 AP 可降低整体医疗保健成本。
大冢制药研发与商业化公司和灵北公司。
