Medical costs and utilization in patients with depression treated with adjunctive atypical antipsychotic therapy

Figures & data

Figure 1 Twelve-month unadjusted and adjusted^a total medical costs.

Notes:^aAdjusted for age, sex, region, index year, preindex number of antidepressants, therapeutic dose range, PDG, MGH-AD, use of mood stabilizers, use of stimulants, use of thyroid, visit to a psychiatric provider, MDD code of 296.2x or 296.3x, diabetes, hyperlipidemia. *P < 0.05 for all comparisons with aripiprazole.
Abbreviations: MDD, major depressive disorder; MGH–AD, Massachusetts General Hospital Scale – antidepressant version; PDG, psychiatric diagrosis group.

Table 1 Characteristics of patients treated with adjunctive aripiprazole, olanzapine, or quetiapine

	Aripiprazole (n = 3142)	Olanzapine (n = 945)	P-value	Quetiapine (n = 5588)	P-value
Demographics
Age, mean (SD)	45.1 (11.9)	46.9 (11.7)	<0.001	44.8 (11.8)	0.220
Sex, % (n)
Women	72.4 (2,276)	62.1 (587)	<0.001	68.1 (3803)	0.0001
Region, % (n)
East	30.5 (957)	29.1 (275)		29.4 (1644)
Midwest	42.4 (1333)	42.1 (398)		43.3 (2419)
West	5.9 (186)	9.0 (85)		7.9 (443)
South	21.2 (666)	19.8 (187)	<0.01	19.4 (1082)	<0.01
Index year, % (n)
2005	3.8 (119)	10.5 (99)		8.5 (474)
2006	9.9 (311)	24.3 (230)		22.2 (1238)
2007	14.3 (450)	30.3 (286)		30.8 (1723)
2008	46.6 (1463)	27.8 (263)		30.9 (1726)
2009	25.4 (799)	7.1 (67)	<0.001	7.6 (427)	<0.001
Comorbid conditions
Deyo CCI, mean (SD)	0.4 (1.0)	0.6 (1.3)	<0.001	0.5 (1.2)	<0.001
PDG, mean (SD)	1.5 (1.1)	1.5 (1.3)	0.873	1.8 (1.3)	<0.001
Diabetes, % (n)	6.9 (218)	5.8 (55)	0.227	6.6 (366)	0.486
Hyperlipidemia, % (n)	14.5 (456)	14.2 (134)	0.798	14.1 (788)	0.598
Disease-severity proxies
Preindex number of antidepressants, % (n)
1	46.8 (1471)	45.8 (433)		43.3 (2422)
2	37.9 (1190)	36.5 (345)		38.4 (2144)
3+	15.3 (481)	17.7 (167)	0.215	18.3 (1022)	<0.001
Dose within therapeutic range at 6 months, % (n)	68.1 (2139)	41.3 (390)	<0.001	22.8 (1273)	<0.001
Dose within therapeutic range at 12 months, % (n)	68.9 (2165)	42.9 (405)	<0.001	24.1 (1347)	<0.001
MGH-AD, mean (SD)	2.2 (1.1)	2.0 (1.2)	<0.001	2.0 (1.2)	<0.001
Preindex mood stabilizer, % (n)	30.8 (969)	26.1 (247)	<0.01	28.1 (1571)	<0.01
Preindex stimulant, % (n)	14.4 (454)	7.0 (66)	<0.001	8.2 (456)	<0.001
Preindex thyroid, % (n)	13.9 (436)	12.0 (113)	0.129	10.8 (606)	<0.001
Visit to psychiatric provider, % (n)	66.4 (2086)	54.0 (510)	<0.001	63.5 (3548)	<0.01
Diagnosis of MDD based on ICD-9 codes of 296.2x or 296.3x, % (n)	78.6 (2469)	67.0 (633)	<0.001	74.0 (4135)	<0.001
Hospitalization, % (n)	15.1 (475)	23.3 (220)	<0.001	27.7 (1548)	<0.001
ER visit, % (n)	25.3 (795)	33.3 (315)	<0.001	39.3 (2197)	<0.001

Abbreviations: SD, standard deviation; CCI, Charlson Comorbidity Index; PDG, psychiatric diagnosis group; MGH-AD, Massachusetts General Hospital scale – antidepressant version; MDD, major depressive disorder; ICD, International Classification of Diseases; ER, Emergency room.

Figure 2 Twelve-month unadjusted and adjusted^a inpatient and outpatient costs.

Notes:^aAdjusted for age, sex, region, index year, pre-index number of antidepressants, therapeutic dose range, PDG, MGH-AD, use of mood stabilizers, use of stimulants, use of thyroid, visit to a psychiatric provider, MDD code of 296.2x or 296.3x, diabetes, hyperlipidemia. *P < 0.05 for all comparisons with aripiprazole.
Abbreviations: Ari, aripiprazole; Olan, olanzapine; Quet, quetiapine; MDD, major depressive disorder; MGH–AD, Massachusetts General Hospital Scale – antidepressant version; PDG, psychiatric diagnosis group.

Table 2 Unadjusted and adjusteda 12-month postindex rates for hospitalization and ER visits

	Aripiprazole (n = 3142)	Olanzapine (n = 945)	Quetiapine (n = 5588)
Unadjusted 12-month postindex rates of hospitalization and ER visits
Hospitalization, % (n)	15.4 (485)	24.6 (232)b	22.0 (1227)b
ER visits, % (n)	29.7 (932)	36.5 (345)b	41.4 (2,315)b
Adjusteda 12-month postindex rates of hospitalization and ER visits
Hospitalization	20.1%b	30.3%b	26.0%b
ER visits	23.1%b	29.6%b	32.8%b

Notes:

a Adjusted for age, sex, region, index year, pre-index number of antidepressants, therapeutic dose range, PDG, MGH-AD, use of mood stabilizers, use of stimulants, use of thyroid, visit to a psychiatric provider, MDD code of 296.2x or 296.3x, diabetes, hyperlipidemia, preindex hospitalization or ER visit;

b P < 0.001 for all comparisons to aripiprazole.

Abbreviations: ER, Emergency room; MDD, major depressive disorder; MGH–AD, Massachusetts General Hospital Scale – antidepressant version; PDG, psychiatric diagnosis group.

Figure 3 Adjusted^a 12 month post-index odds of hospitalization ER visits compared to aripiprazole.

Notes:^aAdjusted for age, gender, region, index year, pre-index number of antidepressants, therapeutic dose range, PDG, MGH-AD, use of mood stabilizers, use of stimulants, use of thyroid, visit to a psych provider, MDD code of 296.2x or 296.3x, diabetes, hyperlipidemia, pre-index hospitalization or ER visit.
Abbreviations: ER, Emergency room; MDD, major depressive disorder; MGH–AD, Massachusetts General Hospital Scale – antidepressant version; PDG, psychiatric diagnosis group.