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Original Articles

One-Year Costs of Second-Line Therapies for Depression

Erin M. Sullivan, Robert I. Griffiths, Richard G. Frank, Michael J. Strauss, Robert J. Herbert, Jon Clouse, and Howard H. Goldman

Published: September 30, 2000

Article Abstract

Background: We compared patterns of
medical resource utilization and costs among patients receiving a
serotonin-norepinephrine reuptake inhibitor (venlafaxine), one of
the selective serotonin reuptake inhibitors (SSRIs), one of the
tricyclic agents (TCAs), or 1 of 3 other second-line therapies
for depression.

Method: Using claims data from a national
managed care organization, we identified patients diagnosed with
depression (ICD-9-CM criteria) who received second-line
antidepressant therapy between 1993 and 1997. Second-line therapy
was defined as a switch from the first class of antidepressant
therapy observed in the data set within 1 year of a diagnosis of
depression to a different class of antidepressant therapy.
Patients with psychiatric comorbidities were excluded.

Results: Of 981 patients included in the study,
21% (N = 208) received venlafaxine, 34% (N = 332) received an
SSRI, 19% (N = 191) received a TCA, and 25% (N = 250) received
other second-line antidepressant therapy. Mean age was 43 years,
and 72% of patients were women. Age, prescriber of second-line
therapy, and prior 6-month expenditures all differed
significantly among the 4 therapy groups. Total,
depression-coded, and non-depression-coded 1-year expenditures
were, respectively, $6945, $2064, and $4881 for venlafaxine;
$7237, $1682, and $5555 for SSRIs; $7925, $1335, and $6590 for
TCAs; and $7371, $2222, and $5149 for other antidepressants. In
bivariate analyses, compared with TCA-treated patients,
venlafaxine- and SSRI-treated patients had significantly higher
depression-coded but significantly lower non-depression-coded
expenditures. Venlafaxine was associated with significantly
higher depression-coded expenditures than SSRIs. However, after
adjustment for potential confounding covariables in multivariate
analyses, only the difference in depression-coded expenditures
between SSRI and TCA therapy remained significant.

Conclusion: After adjustment for confounding
patient characteristics, 1-year medical expenditures were
generally similar among patients receiving venlafaxine, SSRIs,
TCAs, and other second-line therapies for depression. Observed
differences in patient characteristics and unadjusted
expenditures raise questions as to how different types of
patients are selected to receive alternative second-line
therapies for depression.

Volume: 61

Quick Links: Depression (MDD)

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Letter to the Editor

Stigma Kills Psychiatric Patients and Is Now Killing Clinical Research Too

Robert M. Post, MD, argues that NIMH should abandon the RDoC framework and restore funding for clinical...

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