Gauthier Genevieve, Mucha Lisa, Shi Sherry, Guerin Annie
Analysis Group, Inc, Montreal, Canada.
Takeda Development Center Americas, Inc, Deerfield, IL, USA.
J Drug Assess. 2019 May 24;8(1):97-103. doi: 10.1080/21556660.2019.1612410. eCollection 2019.
: This study was conducted to determine the incremental healthcare resource utilization (HRU) and costs associated with relapse or recurrence (R/R) in patients with major depressive disorder (MDD) treated with antidepressants (AD) in US clinical practice. : In this retrospective cohort study, adult patients with MDD treated with a branded AD were selected from the Truven Health Analytics MarketScan Databases (January 1, 2004-March 31, 2015). Time to first indicator of R/R was described. Characteristics, HRU, and costs were compared between patients with and without R/R. Among patients with R/R, HRU and costs were also compared between the pre- and post-R/R period. : From the 22,236 selected patients, 5,541 had ≥ 1 indicator of R/R and 16,695 did not. The 3-year R/R rate varied between 21.3% and 36.4% based on pattern of AD use (continuous, switch/augmentation, or early discontinuation). Patients with and without R/R presented different characteristics-notably, more intensive prior AD use and a higher comorbidity burden. HRU and costs were high in both patients with and without R/R but substantially higher among those with R/R ($20,590 vs $12,368 per-patient-per-year (PPPY); adjusted difference [aDiff] = $7,037), mainly driven by increased inpatient (IP) services (adjusted incidence rate ratio IP days = 3.95; aDiff IP costs = $3,433 PPPY). Among patients with R/R, emergency department visits, IP days, and IP admissions were over 2-times higher during the post-R/R period and total costs increased by over 50% from $19,267 to $29,419 in the post-R/R period. : The economic burden in MDD patients is substantial, but is significantly higher among those who experience R/R.
本研究旨在确定美国临床实践中接受抗抑郁药（AD）治疗的重度抑郁症（MDD）患者复发或再发（R/R）相关的增量医疗资源利用（HRU）和成本。
在这项回顾性队列研究中，从Truven Health Analytics MarketScan数据库（2004年1月1日至2015年3月31日）中选取接受品牌抗抑郁药治疗的成年MDD患者。描述了首次出现R/R指标的时间。比较了有R/R和无R/R患者的特征、HRU和成本。在有R/R的患者中，还比较了R/R前后时期的HRU和成本。
在22236名入选患者中，5541名有≥1个R/R指标，16695名没有。根据抗抑郁药使用模式（持续使用、换药/增效或早期停药），3年R/R率在21.3%至36.4%之间变化。有R/R和无R/R的患者呈现出不同的特征——值得注意的是，之前抗抑郁药使用强度更大，合并症负担更高。有R/R和无R/R的患者医疗资源利用和成本都很高，但有R/R的患者更高（每位患者每年20590美元对12368美元；调整差异[aDiff]=7037美元），主要由住院（IP）服务增加推动（调整后的住院天数发病率比=3.95；调整后的住院成本差异=aDiff IP成本=每位患者每年3433美元）。在有R/R的患者中，R/R后时期急诊就诊、住院天数和住院次数高出2倍多，总成本从R/R前时期的19267美元增加到R/R后时期的29419美元，增加了50%以上。
MDD患者的经济负担很重，但经历R/R的患者负担明显更高。
