Patient journey before and after a formal post-traumatic stress disorder diagnosis in adults in the United States – a retrospective claims study

Abstract

Objective

To describe post-traumatic stress disorder (PTSD)-related symptoms and frequent psychiatric comorbidities, treatments received, healthcare resource utilization (HRU), and healthcare costs pre- and post-PTSD diagnosis among adults in the United States.

Methods

Adults with PTSD who received a PTSD-related pharmacological treatment (selective serotonin reuptake inhibitor [SSRI], serotonin-norepinephrine reuptake inhibitor [SNRI], atypical antipsychotic [AA]) within 24 months of the first observed PTSD diagnosis (index date) were identified using MarketScan Commercial Database (2015–2020). Study outcomes were assessed during the 6-month pre-diagnosis and 24-month post-diagnosis periods. Subgroup analyses included patients treated or not treated with AAs post-PTSD diagnosis.

Results

Of the overall patients (N = 26,306; mean age at diagnosis 39.5 years; 73.3% female), 85.9% had PTSD-related symptoms and frequent psychiatric comorbidities during the 6 months pre-diagnosis. Patients treated with AAs post-PTSD diagnosis (N = 9,298) tended to have higher rates of PTSD-related symptoms and comorbidities at diagnosis than those not treated with AAs (N = 7,011). Following diagnosis, the most commonly observed first-line treatments were SSRI (67.4%), AA (23.4%), and SNRI (22.6%). The rate of PTSD-related symptoms and comorbidities, psychotherapy and pharmacological treatments received, HRU, and healthcare costs increased during the 6 months post-diagnosis relative to the 6 months pre-diagnosis and then declined over time during the 24 months post-diagnosis.

Conclusions

The PTSD diagnosis was associated with increased rates of symptoms and frequent psychiatric comorbidities, psychotherapy and pharmacological treatments received, HRU, and healthcare costs, pointing to increased patient monitoring. Within 6 to 12 months after the PTSD diagnosis, these outcomes tended to reduce, perhaps as patients were obtaining targeted and effective care.

Keywords:

• Adults
• antipsychotic
• comorbidity
• diagnosis
• healthcare costs
• pTSD

Transparency

Declaration of funding

This study was funded by Otsuka Pharmaceutical Development & Commercialization, Inc. and Lundbeck LLC. The study sponsor was involved in several aspects of the research, including the study design, interpretation of data, writing of the manuscript, and decision to submit the manuscript for publication.

Declaration of financial/other relationships

LLD has received research grants from Alkermes, Aptinyx, Social Finance, Veterans Administration, and Westat; and consultancy fees from Boehringer Ingleheim, Otsuka, and Signant Health. JA is an employee of Otsuka Pharmaceutical Development & Commercialization, Inc. AU is an employee of Lundbeck LLC. PGS, JM, MC, and AG are employees of Analysis Group, Inc., a consulting company that has provided paid consulting services to of Otsuka Pharmaceutical Development & Commercialization, Inc. and Lundbeck LLC for the conduct of the current study. WQ was an employee of Analysis Group, Inc. at the time the study was conducted. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

PGS, JM, WQ, MC, and AG contributed to study conception and design, collection and assembly of data, and data analysis and interpretation. LLD, JA, and AU contributed to study conception and design, data analysis and interpretation. All authors have provided final approval of this version to be published and agree to be accountable for all aspects of the work.

Acknowledgements

Medical writing assistance was provided by professional medical writer, Flora Chik, PhD, MWC, an employee of Analysis Group, Inc., and was funded by Otsuka Pharmaceutical Development & Commercialization, Inc. and Lundbeck LLC.

Data availability statement

The data that support the findings of this study are available from IBM. Restrictions apply to the availability of these data, which were used under license for this study. Requests for data should be made directly to IBM.

Ethical approval

Data were de-identified and comply with the patient requirements of the Health Insurance Portability and Accountability Act (HIPAA) of 1996; therefore, no review by an institutional review board was required per Title 45 of CFR, Part 46.101(b)(4) [29].

Previous presentations

Part of the material in this manuscript was presented at the Psych Congress held on September 17–20, 2022, at New Orleans, LA, and at the Academy of Managed Care Pharmacy (AMCP) Annual Meeting held on March 21–24, 2023, in San Antonio, Texas, as poster presentations.