Comparison of Managed Care Charges Among Patients Treated With Selective Serotonin Reuptake Inhibitors for Premenstrual Dysphoric Disorder
J Clin Psychiatry 2003;64(12):1511-1516
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Objective: To determine the impact on managed
care charges of selecting citalopram, fluoxetine, paroxetine, or
sertraline as first-line pharmacotherapy for newly diagnosed
premenstrual dysphoric disorder (PMDD).
Method: This retrospective study analyzed
administrative claims data from 14 managed care plans in the
United States. The study population was identified from an
integrated outcomes database for the period Jan. 1, 1998, to Dec.
31, 1999. Patients aged 18 years or older, newly diagnosed with
PMDD, and initiating therapy with a selective serotonin reuptake
inhibitor (SSRI) within 30 days of the diagnosis were eligible
for analysis. To date, there is no specific ICD-9 diagnosis code
for PMDD; thus, patients were required to have an ICD-9 diagnosis
of premenstrual tension syndrome (ICD-9 625.4). Patients with
documented previous psychiatric disorders/treatment were
excluded. All inpatient, outpatient, and pharmacy claims incurred
by each patient during the study period were included in the
analysis. PMDD-related treatment charges for the 6-month period
following treatment initiation were compared using multivariate
Results: A total of 1413 patients met the study
criteria. Fluoxetine and sertraline were the most common agents
selected as first-line therapy. After differences in age, managed
care plan, pretreatment resource utilization, physician
specialty, index prescription year, treatment charges, presence
of mental health and nonmental health comorbid conditions, and
changes in medication were controlled for, patients taking
paroxetine and citalopram had significantly higher PMDD-related
treatment charges than sertraline patients (paroxetine, p =
.0430; citalopram, p = .0226). Fluoxetine patients also had
higher treatment charges than sertraline patients, though
statistical significance was not reached.
Conclusions: Sertraline, as first-line therapy
for PMDD, was associated with lower PMDD-related treatment
charges compared with other SSRIs during the first 6 months after