ZRx Outcomes Research Inc., Mississauga, ON, Canada.
Lykos Therapeutics, San Jose, CA, United States of America.
PLoS One. 2024 Oct 30;19(10):e0309704. doi: 10.1371/journal.pone.0309704. eCollection 2024.
This retrospective claims analysis explored the treatment utilization and characteristics among patients with post-traumatic stress disorder (PTSD) of different severity.
The index date was the first PTSD claim. The analysis observed 12 months pre- and 24 months post-index. Adults with insurance gaps, cancer, or acute PTSD during the observation were excluded. Patients were categorized into three severity cohorts based on treatment and healthcare services utilization for PTSD: 1. Baseline PTSD (BP) (no PTSD visits post-index, no FDA-approved medications/ psychotherapy, and no severe mental health comorbidities); 2. PTSD without Comorbidities (PwoC) (≥1 PTSD visits post-index and no severe mental health conditions); 3. PTSD with Comorbidities (PwC) (≥1 PTSD visits post-index and severe mental health comorbidities present). For the primary analysis, cohorts were propensity-score matched. A sub-analysis examined patients with PTSD and Substance or Alcohol Use Disorder (SUD/AUD).
The primary analysis observed 1714 BP, 1681 PwoC, and 1681 PwC patients. Treatment utilization rates were highest among PwC vs. other cohorts (84.5% psychotherapy, 76.1% off-label medications, and 26.1% FDA-approved medications [p<0.001]). PwC cohort also had the highest number of psychotherapy sessions and medication prescriptions per patient (20.1 sessions, 12.6 off-label prescriptions, and 2.0 FDA-approved prescriptions [p<0.001]). The proportion of days covered (PDC) indicated low medication adherence (0.25-0.40) with adherent patient rates (PDC ≥0.80) between 8.0-17.5%. The SUD/AUD sub-analysis identified 85 BP, 537 PwoC, and 3154 PwC patients. Conclusions were similar, with PwC cohort having highest treatment utilization rates (87.1% psychotherapy, 85.0% off-label medications, 28.2% FDA-approved medications [p≤0.013] with 24.4 sessions, 16.1 off-label prescriptions, and 2.0 FDA-approved prescriptions per patient [p≤0.002]). Only 4.7-11.4% of patients were adherent.
PwC patients received psychotherapy and pharmacotherapy more frequently than PwoC and BP patients. Medication adherence among treated patients was low. Patients with SUD/AUD had numerically higher treatment utilization and lower medication adherence.
本回顾性理赔分析探讨了不同严重程度的创伤后应激障碍（PTSD）患者的治疗利用情况和特征。
索引日期为首次 PTSD 理赔。分析观察了索引前 12 个月和索引后 24 个月。排除了观察期间有保险空白、癌症或急性 PTSD 的患者。根据 PTSD 的治疗和医疗服务利用情况，将患者分为三个严重程度队列：1. 基线 PTSD（BP）（无 PTSD 就诊，无 FDA 批准的药物/心理治疗，无严重精神共病）；2. 无共病 PTSD（PwoC）（≥1 次 PTSD 就诊，无严重精神疾病）；3. 共病 PTSD（PwC）（≥1 次 PTSD 就诊和存在严重精神共病）。主要分析中，对队列进行倾向评分匹配。子分析考察了 PTSD 和物质/酒精使用障碍（SUD/AUD）患者。
主要分析观察了 1714 名 BP、1681 名 PwoC 和 1681 名 PwC 患者。与其他队列相比，PwC 组的治疗利用率最高（84.5%心理治疗、76.1%非标签药物和 26.1% FDA 批准药物[均 p<0.001]）。PwC 队列每位患者的心理治疗次数和药物处方也最多（20.1 次、12.6 次非标签处方和 2.0 次 FDA 批准处方[均 p<0.001]）。药物覆盖天数（PDC）表明药物依从性低（0.25-0.40），依从性患者比例（PDC≥0.80）在 8.0-17.5%之间。SUD/AUD 子分析确定了 85 名 BP、537 名 PwoC 和 3154 名 PwC 患者。结论相似，PwC 队列的治疗利用率最高（87.1%心理治疗、85.0%非标签药物、28.2% FDA 批准药物[均 p≤0.013]，每位患者的心理治疗次数、非标签处方和 FDA 批准处方分别为 24.4 次、16.1 次和 2.0 次[均 p≤0.002]）。只有 4.7-11.4%的患者依从治疗。
与 PwoC 和 BP 患者相比，PwC 患者接受心理治疗和药物治疗的频率更高。接受治疗的患者药物依从性低。患有 SUD/AUD 的患者治疗利用率更高，药物依从性更低。
