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Abstract
Objective: To evaluate the association between adherence to antidepressants and an effect on clinical outcomes and healthcare costs in patients with major depressive disorder (MDD) and comorbid type 2 diabetes (T2D).
Methods: This retrospective study used MarketScan claims data from January 2012 to March 2014. Study entry was the first claim for an antidepressant and a diagnosis code for MDD and T2D in the prior 6 months. Adherence and persistence with antidepressant therapy in the first 180 days were defined as medication possession ratio (MPR) ≥ 80% and length of therapy (LOT), with no treatment gap of >15 days, respectively. T2D control (HbA1c <7%), oral diabetes medication adherence, and healthcare costs were measured in the 12 month post-index period. The impact of antidepressant adherence and persistence on outcomes was assessed using multivariable analyses.
Results: Among the 1361 patients included, the mean age was 59 years and 55% were women. About one-third of the patients were adherent (35.9%, mean MPR = 40%), persistent (32.0%, average LOT = 100 days), and adherent/persistent (31.2%) on antidepressants. Being adherent, persistent, or adherent/persistent to antidepressants was associated with a two-fold improvement in adherence to oral diabetes medications. Of those with HbA1c data (n = 121), adherence or adherence/persistence to antidepressants was associated with patients being five times more likely to have T2D control (odds ratio [OR]: 4.95; 95% confidence interval [CI]: 1.39, 17.59, p = .0134). Comparison between antidepressant-persistent and non-persistent patients was not significant. Mean difference in adjusted all-cause annual costs showed lower costs among antidepressant-adherent and adherent/persistent patients (adherent: -$350, 95% CI: -$462, -$247; adherent/persistent: -$1165; 95% CI: -$1280, -$1060).
Conclusions: Patients with better antidepressant adherence and adherence/persistence demonstrated better HbA1c control, with lower all-cause total and medical costs. Adherence, persistence, or adherence/persistence to antidepressants was associated with improved adherence to oral diabetes medications.
Transparency
Declaration of funding
This study was funded by Takeda Pharmaceuticals. Xcenda LLC received funding from Takeda Pharmaceuticals to conduct this study.
Declaration of financial/other relationships
C.V. has disclosed that he is an employee of the University of California, Irvine, and a consultant to Takeda Pharmaceuticals. R.V.B. has disclosed that he is a consultant to Takeda Pharmaceuticals. L.M. and B.H.L. have disclosed that they are employees of Takeda Pharmaceuticals. M.T.E. and A.O.O. have disclosed that they are employees of Xcenda LLC, AmerisourceBergen. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.
CMRO peer reviewers on this manuscript have disclosed that they have no relevant financial or other relationships.
Author contributions
All authors contributed to the concept and design of the study, interpretation of the results, writing and revisions of the manuscript, and approval of the final version submitted for publication. M Eaddy and A Ogbonnaya also contributed to the conduct of the analysis. All authors agree to be accountable for all aspects of the work.
Acknowledgements
L. Ho, an employee of Xcenda LLC, AmerisourceBergen, provided medical writing assistance, which was funded by Takeda Pharmaceuticals.
Previous presentation: 56th Annual American Society of Clinical Psychopharmacology (ASCP) Meeting, Scottsdale, AZ, USA, 30 May–3 June 2016.