Economic burden associated with inadequate antidepressant medication management among patients with depression and known cardiovascular diseases: insights from a United States–based retrospective claims database analysis

Abstract

Aims: The current study examined the association between insufficient major depressive disorder (MDD) care and healthcare resource use (HCRU) and costs among patients with prior myocardial infarction (MI) or stroke.

Methods: This was a retrospective study conducted using the MarketScan Claims Database (2010–2015). The date of the first MI/stroke diagnosis was defined as the cardiovascular disease (CVD) index date and the first date of a subsequent MDD diagnosis was the index MDD date. Adequacy of MDD care was assessed during the 90 days following the index MDD date (profiling period) using 2 measures: dosage adequacy (average fluoxetine equivalent dose of ≥20 mg/day for nonelderly and ≥10 mg/day for elderly patients) and duration adequacy (measured as the proportion of days covered of 80% or higher for all MDD drugs). Study outcomes included all-cause and CVD-related HCRU and costs which were determined from the end of the profiling period until the end of study follow-up. Propensity-score adjusted generalized linear models (GLMs) were used to compare patients receiving adequate versus inadequate MDD care in terms of study outcomes.

Results: Of 1,568 CVD patients who were treated for MDD, 937 (59.8%) were categorized as receiving inadequate MDD care. Results from the GLMs suggested that patients receiving inadequate MDD care had 14% more all-cause hospitalizations, 4% more all-cause outpatient visits, 17% more CVD-related outpatient visits, 13% more CVD-related emergency room (ER) visits, higher per patient per year CVD-related hospitalization costs ($21,485 vs. $17,756), higher all-cause outpatient costs ($2,820 vs. $2,055), and higher CVD-related outpatient costs ($520 vs. $434) compared to patients receiving adequate MDD care.

Limitations: Clinical information such as depression severity and frailty, which are potential predictors of adverse CVD outcomes, could not be ascertained using administrative claims data.

Conclusions: Among post-MI and post-stroke patients, inadequate MDD care was associated with a significantly higher economic burden.

Keywords:

• Major depressive disorder (MDD)
• cardiovascular disease (CVD)
• myocardial infarction (MI)
• economic burden
• MarketScan
• adequacy of care

Transparency

Declaration of funding

The study was funded by Pfizer Inc.

Declaration of financial/other interests

Ruchit Shah, Xin Gao, and Jennifer Stephens are employees of Pharmerit International, LP, which received research funding from Pfizer Inc. for this study. Chinmay Deshpande was an employee of Pharmerit International, LP, when the study was conducted. Ahmed Shelbaya, Elizabeth Pappadopulos, and Patricia Schepman are employees of Pfizer Inc. and own Pfizer stock. Rita Prieto works for Pfizer GEP S.L.U. Spain and owns Pfizer stock.

JME peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

The study was designed by Sripal Bangalore, Ruchit Shah, Xin Gao, Elizabeth Pappadopulos, Chinmay Deshpande, Ahmed Shelbaya, Rita Prieto, Jennifer Stephens, Patricia Schepman, and Roger McIntyre. The data were analyzed by Ruchit Shah and Chinmay Deshpande. Sripal Bangalore, Ruchit Shah, Xin Gao, Elizabeth Pappadopulos, Chinmay Deshpande, Ahmed Shelbaya, Rita Prieto, Jennifer Stephens, Patricia Schepman, and Roger McIntyre wrote the paper. All authors read and approved the final version of the manuscript.

Acknowledgements

The authors would like to thank the Pharmerit project team members Rachel Shah and Zhiyong Chen for their contributions to the research, interpretation, and critical review.

Previous presentations

An earlier version of this analysis was presented as a poster at the American Managed Care and Specialty Pharmacy Annual Meeting 2018 (April 24–26, 2018).