Sclar D A, Robison L M, Skaer T L, Legg R F, Nemec N L, Galin R S, Hughes T E, Buesching D P
College of Pharmacy, Washington State University.
Clin Ther. 1994 Jul-Aug;16(4):715-30; discussion 74. doi: 10.1016/s0011-393x(05)80275-9.
Recent pharmacotherapeutic advances in the treatment of depression have included the development of selective serotonin re-uptake inhibitors (SSRIs). The present study was designed to contrast direct health service expenditures for the treatment of depression among patients enrolled in a health maintenance organization (HMO) and prescribed either the SSRI fluoxetine or one of three tricyclic antidepressants (TCAs) (amitriptyline, nortriptyline, or desipramine). Information regarding health service utilization was derived from the computer archive of a network-model HMO system serving 400,000 beneficiaries. A total of 701 HMO beneficiaries were found to satisfy the study selection criteria. Multivariate regression analysis was used to discern the incremental influence of selected demographic, clinical, financial, and provider characteristics on 1 year post-period expenditures (PPE) for health care. Analysis-of-variance procedures with Duncan's multiple-range test, or chi-square analyses, revealed no significant difference across antidepressant pharmacotherapy for age, sex, 6-month prior-period expenditures for physician visits, psychiatric visits, laboratory tests, hospitalizations, or psychiatric hospital services related to the treatment of depression, or number of prescribed therapeutic agents for disease state processes other than depression. Receipt of fluoxetine was associated with a significantly (P < or = 0.05) higher rate of initial prescribing by psychiatrists, an increase in the number of prescriptions for antidepressant pharmacotherapy obtained (30-day supplies), and a reduction in the number of monthly intervals during which time antidepressant pharmacotherapy was not procured. Receipt of fluoxetine as antidepressant pharmacotherapy was associated with a significantly (P < or = 0.05) higher mean medication possession ratio (MPR) relative to amitriptyline, nortriptyline, or desipramine. Multivariate findings for patient-level data reflecting a definitive diagnosis of depression (n = 555) indicate that receipt of a TCA resulted in a significant (P < or = 0.05) increase in the use of physician visits ($36.07), psychiatric visits ($41.38), laboratory tests ($1.71), hospitalizations ($208.77), and psychiatric hospital services ($187.27), and a significant (P < or = 0.05) reduction in expenditures for antidepressant pharmacotherapy (-$162.21), for a total increase in health service utilization of $312.99 (P < or = 0.05) 1 year post-initiation of antidepressant pharmacotherapy.(ABSTRACT TRUNCATED AT 250 WORDS)
近期抑郁症治疗在药物治疗方面取得的进展包括选择性5-羟色胺再摄取抑制剂（SSRI）的研发。本研究旨在对比健康维护组织（HMO）中登记在册且被开具SSRI氟西汀或三种三环类抗抑郁药（TCA，即阿米替林、去甲替林或地昔帕明）之一的抑郁症患者的直接医疗服务支出。关于医疗服务利用情况的信息源自一个为40万受益者服务的网络模式HMO系统的计算机存档。共发现701名HMO受益者符合研究选择标准。采用多变量回归分析来识别选定的人口统计学、临床、财务和医疗服务提供者特征对1年后期医疗保健支出（PPE）的增量影响。方差分析程序结合邓肯多重极差检验或卡方分析显示，在年龄、性别、抑郁症治疗相关的6个月前期医生诊疗、精神科诊疗、实验室检查、住院或精神病院服务支出，或除抑郁症外疾病状态过程的处方治疗药物数量方面，不同抗抑郁药物疗法之间无显著差异。接受氟西汀治疗与精神科医生初始开方率显著较高（P≤0.05）、获得的抗抑郁药物疗法处方数量（30天用量）增加以及未获得抗抑郁药物疗法的月度间隔数量减少相关。与阿米替林、去甲替林或地昔帕明相比，接受氟西汀作为抗抑郁药物疗法的平均药物持有率（MPR）显著较高（P≤0.05）。反映明确抑郁症诊断的患者层面数据的多变量研究结果（n = 555）表明，接受TCA治疗导致医生诊疗（36.07美元）、精神科诊疗（41.38美元）、实验室检查（1.71美元）、住院（208.77美元）和精神病院服务（187.27美元）的使用显著增加（P≤0.05），抗抑郁药物疗法支出显著减少（-162.21美元），抗抑郁药物疗法开始后1年医疗服务利用总增加312.99美元（P≤0.05）。（摘要截选至250词）
