Antidepressant therapeutic strategies and health care utilization in patients with depression
Publication: Journal of Managed Care & Specialty Pharmacy
Volume 30, Number 12
Abstract
BACKGROUND:
Individuals with depression who do not respond to initial antidepressant may switch to a different antidepressant, add a second antidepressant, or add an atypical antipsychotic. Previous studies comparing these strategies’ efficacy and safety reported conflicting results, and the impact of these strategies on subsequent health care utilization is unknown.
OBJECTIVE:
To compare health care utilization between individuals with depression who switched antidepressants, added a second antidepressant (ie, combination), or added an atypical antipsychotic (ie, augmentation) following their initial antidepressant.
METHODS:
This retrospective cohort study used a 25% random sample of the IQVIA PharMetrics Plus for Academics health plan claims database. The study cohort included individuals aged 10-64 years who newly initiated an antidepressant at any point from January 2016 to December 2020. New use was defined as no evidence of an antidepressant in the 180 days preceding the antidepressant dispensing. Individuals had to have a depression diagnosis and a treatment change in the 180 days following the initial antidepressant. The index date was the date of the first observed antidepressant change, which was defined as a switch, combination, or augmentation. Health care utilization, measured as the number of outpatient visits, any all-cause hospitalization, and any emergency department (ED) visit, was assessed in the 180 days after the index date. Negative binomial regression models evaluated the rate ratio of the number of outpatient visits. Logistic regression models estimated the odds ratio of a hospitalization, and modified Poisson regression estimated the relative risk of an ED visit. Models were adjusted for demographics, clinical characteristics, and previous health care utilization.
RESULTS:
Among 3,847 individuals with depression who had the first treatment change following the initial antidepressant, we identified 2,418 (62.9%) who switched, 1,268 (33.0%) who combined, and 161 (4.2%) who augmented their antidepressant. The augmentation group had a significantly higher rate of outpatient visits than the combination group (adjusted rate ratio = 1.14, 95% CI = 1.04-1.25). There was no statistically significant difference in hospitalizations or ED visits between the switch and augmentation vs combination groups.
CONCLUSIONS:
Augmentation comprised 4% of our antidepressant cohort but had higher outpatient health care utilization than those who combined treatment.
Plain language summary
Individuals with depression who switch to a different antidepressant or add a second antidepressant to their initial antidepressant have similar use of outpatient, inpatient, and emergency department visits within 180 days of follow-up. Individuals who augment their initial antidepressant with an atypical antipsychotic medication have higher use of outpatient visits relative to those who combine with an antidepressant.
Implications for managed care pharmacy
Individuals who add an atypical antipsychotic to their antidepressant may have more impairment because of depression and require more outpatient health care services than those who combine treatment with an antidepressant. There were no differences across the 3 treatment strategies in terms of hospitalization or emergency department visits. Augmentation strategies should be reserved for individuals on antidepressant medications for at least 84 days (acute phase treatment) or for at least 180 days (continuation phase treatment).
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Published In
Journal of Managed Care & Specialty Pharmacy
Volume 30 • Number 12 • December 2024
Pages: 1455 - 1466
Copyright
Copyright © 2024, Academy of Managed Care Pharmacy. All rights reserved.
History
Published online: 29 November 2024
Published in print: December 2024
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