PMH22: PATTERNS OF ANTIDEPRESSANT USE AND HEALTH CARE COSTS IN DEPRESSED PATIENTS WHO RECEIVED SSRI THERAPY

OBJECTIVES: To assess differences in the health care resource use of patients who received selective serotonin reuptake inhibitor (SSRI) antidepressants. METHODS: Retrospective analysis of administrative medical claims from 1/97–12/99 was conducted using Protocare Sciences' Managed Care Database. Patients were categorized as early discontinued or continued ( one agent). Total health care costs were compared across these categories. RESULTS: Under half (48%) of the 11,119 SSRI users studied continued antidepressant therapy for at least 6 months. Two-thirds of all patients received monotherapy; 19% switched agents (44% of switches were in the first three months of therapy); 15% used multiple agents. Eight percent of patients who discontinued early had switched agents within the specified 6 month period; 90% of these switches occurred in the first three months. For patients who continued therapy for 6 months, the average total health care charges per patient per month (PPPM) during the first three therapy months were $906 (switch by third month), $568 (switch by sixth month), $496 (switch by twelfth month) and $375 (switch after twelfth month). PPPM charges in the first six therapy months ranged from $452–$921 for discontinued patients and from $423–$483 for non-switched, continued patients. CONCLUSIONS: Patients who discontinued SSRI therapy early tended to have higher costs than patients who continued therapy. It is unclear whether these increased costs stem from treatment of medication side effects or increased utilization related to lack of efficacy of the initial antidepressant. Alternatively, early switchers may simply be more clinically complex patients.