Changes in healthcare resource use and costs associated with early versus delayed initiation of atypical antipsychotic adjunctive treatment in major depressive disorder

Abstract

Aims: The study compared all-cause and major depressive disorder (MDD)-related healthcare resource use (HRU) and costs in patients with MDD treated with atypical antipsychotic (AAP) adjunctive therapy early or later in treatment.

Materials and methods: Adults with MDD and antidepressant treatment (ADT) who newly initiated adjunctive aripiprazole, brexpiprazole, lurasidone, or quetiapine between October 1, 2014 and September 30, 2015 were identified in the IQVIA Real-World Data Adjudicated Claims database; the index date was the date of the first AAP claim. Patients were stratified into three cohorts: AAP initiated in the first year (Y1); in the second year (Y2); and more than 2 years (Y3) of first ADT use. Within each cohort, HRU and costs were compared between the 12 months before and after the index date. Pre–post changes in HRU and costs were then compared between cohorts.

Results: Five hundred and six (36.7%) patients were categorized as Y1; 252 (18.3%) as Y2; and 622 (45.1%) as Y3. AAP use was associated with significantly decreased rates of all-cause and MDD-related hospitalization and emergency department visits, and increased rates of pharmacy fills and physician office visits; and the magnitude of changes was largest in cohort Y1. Cohort Y1 had the largest reductions in mean (±SD) all-cause medical costs per patient (−$10,496 ± $85,022, p = .015) compared to Y2 (−$2,474 ± $85,022, p = .572) and Y3 (−$472 ± $31,334, p = .823), mainly due to the reduction in hospitalization. After adjusting for differences in baseline characteristics, the largest reductions in hospitalization and medical costs were observed in cohort Y1. Similar increases in all-cause pharmacy costs were seen in all cohorts. A similar trend in costs was observed in MDD-related healthcare services.

Limitations and conclusions: AAP treatment was associated with reductions in all-cause and MDD-related medical costs, primarily in decreased hospitalization. The reductions were largest among patients who initiated treatment in the first year.

Keywords:

• Atypical antipsychotics
• Major depressive disorder
• Healthcare resource use
• Healthcare cost
• Hospitalization
• Medical cost
• Pharmacy cost

JEL classification codes:

• I10
• I19

Transparency

Declaration of funding

This study was funded by Otsuka Pharmaceutical Development & Commercialization, Inc and Lundbeck, USA. Employees of Otsuka Pharmaceutical Development & Commercialization, Inc. and Lundbeck, USA were involved in the data analysis and interpretation, and in the preparation of the manuscript.

Declaration of financial/other interests

AS and CB were contracted by Otsuka Pharmaceutical Development & Commercialization, Inc. and Lundbeck, USA to conduct this study. MG is an employee of Otsuka Pharmaceutical Development & Commercialization, Inc.; AH is an employee of Lundbeck, USA. Peer reviewers on this manuscript have received an honorarium from JME for their review work. One reviewer discloses that they served on an advisory board for Otsuka in 2017, but the remaining reviewers have no other relevant financial relationships to disclose.

Acknowledgments

Medical writing support was provided by Eileen Han of IQVIA, and was funded by Otsuka Pharmaceutical Development & Commercialization, Inc. and Lundbeck, USA.

Previous presentations

Results from this study were included in posters presented at ISPOR Baltimore, 19–23 May 2018.