Analysis Group, Inc., Montreal, QC, Canada.
Janssen Scientific Affairs, LLC, Titusville, NJ, USA.
Pharmacoeconomics. 2021 Jun;39(6):707-720. doi: 10.1007/s40273-021-01042-5. Epub 2021 May 27.
Suicidal ideation or behavior are core symptoms of major depressive disorder (MDD). This study aimed to understand heterogeneity among patients with MDD and acute suicidal ideation or behavior.
Adults with a diagnosis of MDD on the same day or 6 months before a claim for suicidal ideation or behavior (index date) were identified in the MarketScan Databases (10/01/2014-04/30/2019). A mathematical algorithm was used to cluster patients on characteristics of care measured pre-index. Patient care pathways were described by cluster during the 12-month pre-index period and up to 12 months post-index.
Among 38,876 patients with MDD and acute suicidal ideation or behavior, three clusters were identified. Across clusters, pre-index exposure to mental healthcare was revealed as a key differentiator: Cluster 1 (N = 16,025) was least exposed, Cluster 2 (N = 5640) moderately exposed, and Cluster 3 (N = 17,211) most exposed. Patients whose MDD diagnosis was first observed during their index event comprised 86.0% and 72.8% of Clusters 1 and 2, respectively; in Cluster 3, all patients had an MDD diagnosis pre-index. Within 30 days post-index, in Clusters 1, 2, and 3, respectively, 79.3%, 85.2%, and 88.2% used mental health services, including outpatient visits for MDD. Within 12 months post-index, 61.5%, 91.5%, and 84.6% had one or more antidepressant claim, respectively. Per-patient index event costs averaged $5614, $6645, and $5853, respectively.
Patients with MDD and acute suicidal ideation or behavior least exposed to the healthcare system pre-index similarly received the least care post-index. An opportunity exists to optimize treatment and follow-up with mental health services.
自杀意念或行为是重度抑郁症（MDD）的核心症状。本研究旨在了解有急性自杀意念或行为的 MDD 患者的异质性。
在 MarketScan 数据库中（2014 年 10 月 1 日至 2019 年 4 月 30 日），根据自杀意念或行为的索赔日期（索引日期）当天或前 6 个月，确定 MDD 成年患者。使用数学算法对索引前测量的护理特征对患者进行聚类。在索引前 12 个月和索引后 12 个月内，描述患者的护理路径。
在 38876 例有急性自杀意念或行为的 MDD 患者中，识别出 3 个聚类。在各聚类中，索引前精神保健的暴露情况是关键的区别因素：聚类 1（N=16025）的暴露程度最低，聚类 2（N=5640）的暴露程度中等，聚类 3（N=17211）的暴露程度最高。在聚类 1 和 2 中，MDD 诊断首次观察到的患者分别占 86.0%和 72.8%；在聚类 3 中，所有患者均在索引前患有 MDD 诊断。在索引后 30 天内，聚类 1、2 和 3 中分别有 79.3%、85.2%和 88.2%的患者使用了精神卫生服务，包括 MDD 的门诊就诊。在索引后 12 个月内，分别有 61.5%、91.5%和 84.6%的患者有一次或多次抗抑郁药的索赔。每位患者的索引事件平均费用分别为 5614 美元、6645 美元和 5853 美元。
索引前对医疗系统暴露程度最低的 MDD 患者和有急性自杀意念或行为的患者，索引后接受的护理也最少。有机会优化精神卫生服务的治疗和随访。
