Impact of initiation timing of SSRI or SNRI on depressed adolescent healthcare utilization and costs

Abstract

Background:

Adolescents with newly diagnosed depression may not receive timely antidepressant therapy. Clinical and economic effects of early versus late treatment initiation are unclear.

Objective:

To compare effects of early versus late initiation of second-generation (SSRI/SNRI) antidepressants on emergency room (ER) visits, hospitalizations and healthcare costs in adolescents with depression.

Methods:

Patients aged 12–17 with a diagnosis of depression were identified in a claims database (1999–2007). Patients initiating antidepressants within 1 month of initial diagnosis were considered early initiators; patients initiating within 2–12 months were late initiators. Clinical resource use and healthcare costs were measured during the 6-month pre-index and 12-month post-index (study) periods and compared descriptively between groups. Logistic regression compared healthcare services utilization; a generalized linear model compared costs. All models were adjusted for baseline characteristics, including demographics, comorbidities, and healthcare services utilization.

Results:

A total of 7344 adolescents met study criteria. 4415 (60%) initiated antidepressant treatment within 1 month of diagnosis. At baseline, early initiators had more all-cause inpatient visits (14 vs. 7%) and all-cause ER visits than late initiators (25 vs. 21%, both p < 0.01). They had higher medical ($1434 vs. $1160) and total costs ($1565 vs. $1290) (both p < 0.01). In the study period, late initiators had higher risk of ER visits (OR = 1.13, p = 0.03). They incurred higher medical costs ($5415 vs. $4061) and higher total healthcare costs ($6001 vs. $4907), but lower adjusted drug costs ($767 vs. $888) (all p < 0.01).

Limitations:

Clinical data are scarce in the claims database, and the ability to observe disease severity and reasons for delayed treatment is limited. The definition of early and late initiation was based on empirical analysis, and no clear cutoff was identified beyond what was observed in the data.

Conclusions:

Adolescents who initiated SSRI/SNRI therapy earlier experienced lower risk of ER visits and had lower total costs compared to late initiators.

Key words::

• Adolescent
• Depression
• Early treatment
• Second-generation antidepressants
• SNRI
• SSRI

Transparency

Declaration of funding

This study was funded by Forest Research Institute.

Declaration of financial/other relationships:

A.P.Y., A.K., R.B., J.X., R.B.-H., and E.Q.W. are employees of Analysis Group, Inc. S.B. is an employee of Forest Research Institute. M.H.E. was an employee of Forest Research Institute at the time the study was conducted.

Acknowledgments

Ms Jun Yan, an independent medical writer, contributed to drafting this manuscript.

This study was funded by Forest Research Institute and was presented at the Academy of Managed Care Pharmacy’s Educational Conference in San Antonio, TX, USA, October 7–10, 2009.