School of Pharmacy, Sungkyunkwan University, Gyeonggi-do, Republic of Korea.
National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea.
J Med Econ. 2021 Jan-Dec;24(1):589-597. doi: 10.1080/13696998.2021.1918922.
We aimed to determine the incidence of and identify the factors associated with treatment-resistant depression (TRD), psychiatric conditions, hospitalization, and cost in patients with major depressive disorder (MDD) who were treated using second-line strategies after an inadequate response to initial antidepressants (AD).
Using South Korean National Health Insurance claims data (1 January 2013 to 30 June 2018), we conducted a retrospective cohort analysis in newly treated patients with MDD who subsequently switched or added AD, or added atypical antipsychotics (AAPs) as a second-line treatment. We assessed the incidence of treatment-resistant depression (TRD), psychiatric conditions, and hospitalization for the first 2 years and costs in the third year. Odds ratios (ORs) or relative ratios were estimated using logistic and linear regression models to identify the risk factors for clinical and economic outcomes.
In 15,887 patients, the TRD was 16.81% during the 24-month follow-up period (14.14% in switching AD, 19.65% in adding AD, and 19.91% in adding AAP; < 0.0001). When adding AD or AAP, the OR of TRD was 1.43 (95% confidence interval (CI): 1.30-1.56) and 1.42 (95% CI: 1.23-1.65), respectively, compared to switching AD. However, these factors were not associated with the incidence of psychiatric conditions. Adding AAP increased hospitalization (OR = 1.25, 95% CI: 1.11-1.41), the number of inpatient days by 2.57-fold (95% CI: 1.75-3.76), and cost by 1.20-fold (95% CI: 1.02-1.40), compared to switching AD; adding AD did not show a significant association with these outcomes.
In patients with MDD with inadequate responses to initial AD, TRD still occurred after subsequent treatments according to clinical guidelines. Since the effectiveness of second treatment strategies can differ in reality, further analysis of the clinical and economic evidence regarding second treatment strategies, such as adding AD or AAP, is needed using real-world data.
我们旨在确定在初始抗抑郁药（AD）治疗反应不足后，采用二线策略治疗的重度抑郁症（MDD）患者中，治疗抵抗性抑郁症（TRD）、精神状况、住院和费用的发生率，并确定与这些因素相关的因素。
利用韩国国家健康保险索赔数据（2013 年 1 月 1 日至 2018 年 6 月 30 日），我们对随后转换或添加 AD 或添加作为二线治疗的非典型抗精神病药（AAP）的新治疗 MDD 患者进行了回顾性队列分析。我们评估了前 2 年的 TRD（治疗抵抗性抑郁症）、精神状况和住院治疗情况，以及第 3 年的费用。使用逻辑和线性回归模型估计比值比（ORs）或相对比值，以确定临床和经济结果的危险因素。
在 15887 名患者中，在 24 个月的随访期间，TRD 的发生率为 16.81%（转换 AD 为 14.14%，添加 AD 为 19.65%，添加 AAP 为 19.91%；<0.0001）。与转换 AD 相比，添加 AD 或 AAP 时，TRD 的 OR 分别为 1.43（95%置信区间（CI）：1.30-1.56）和 1.42（95%CI：1.23-1.65）。然而，这些因素与精神状况的发生无关。与转换 AD 相比，添加 AAP 增加了住院（OR=1.25，95%CI：1.11-1.41）、住院天数增加了 2.57 倍（95%CI：1.75-3.76）和费用增加了 1.20 倍（95%CI：1.02-1.40）。添加 AD 与这些结果无显著相关性。
在初始 AD 治疗反应不足的 MDD 患者中，根据临床指南，二线治疗后仍会发生 TRD。由于二线治疗策略的有效性在现实中可能有所不同，因此需要使用真实世界数据进一步分析添加 AD 或 AAP 等二线治疗策略的临床和经济证据。
