Does the use of atypical antipsychotics as adjunctive therapy in depression result in cost savings? Comparing healthcare costs and utilization between second-line treatment options
Does the use of atypical antipsychotics as adjunctive therapy in depression result in cost savings? Comparing healthcare costs and utilization between second-line treatment options
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使用非典型抗精神病药作为抑郁症的辅助治疗是否可以节省成本？
DOI：
10.3109/09638237.2015.1078879
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发表时间：
2016
影响因子：
3.3
通讯作者：
B. Neas
中科院分区：
文献类型：
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作者：
Amany K. Hassan;K. Farmer;Nancy Brahm;Shellie L. Keast;Nancy J Nesser;B. Neas
摘要背景：几种非典型抗精神病药（AAP）被用作治疗难治性抑郁症的二线药物。与其他治疗方案相比，AAP 可能很昂贵，并且可能会引起多种副作用。目标：与其他二线药物相比，估算 AAP 的医疗成本和利用率。方法：使用医疗补助索赔数据（2006-2011 年）进行观察性研究。受试者是被诊断患有抑郁症的成年成员，至少服用过两次抗抑郁药物处方，然后服用二线药物。使用倾向评分调整个体基线特征后，伽玛广义线性模型 (GLM) 对治疗组之间的平均支出差异进行了估计。负二项式模型对住院次数和急诊科 (ED) 就诊次数的差异进行了估计。结果：共有3910名会员接受二线治疗。治疗组包括 AAP（n = 2211）、AAP 以外的增强剂（n = 1008）和抗抑郁药转换组（n = 691）。 AAP 导致平均调整后的药房成本和平均调整后的心理健康相关总成本更高。平均调整后的总医疗费用以及住院和急诊就诊次数在治疗之间没有差异。结论：结果表明，与其他治疗策略相比，没有证据表明 AAP 作为抑郁症二线治疗可以节省总体成本或减少住院和急诊就诊次数。
Abstract Background: Several atypical antipsychotics (AAPs) are used as second-line agents for treatment resistant depression. AAPs can be expensive compared to other treatment options and can cause several side effects. Objectives: To estimate healthcare costs and utilization of AAPs compared to other second-line agents. Methods: Observational study using Medicaid claims data (2006–2011). Subjects were depression-diagnosed adult members with at least two prescriptions of antidepressant medications followed by a second-line agent. Gamma generalized linear models (GLM) produced estimates of the difference in mean expenditures among treatment groups after adjusting for individual baseline characteristics using propensity scores. Negative binomial models produced estimates of the difference in number of hospitalizations and emergency department (ED) visits. Results: A total of 3910 members received second-line treatment. Treatment groups were AAPs (n = 2211), augmentation agents other than AAPs (n = 1008), and antidepressant switching (n = 691). AAPs resulted in higher mean adjusted pharmacy costs and higher mean adjusted total mental health-related costs. Mean adjusted total healthcare costs and number of inpatient and ED visits were not different among treatments. Conclusion: The results show no evidence that AAPs used as second-line treatment for depression results in overall cost savings or lower inpatient and ED visits compared to other treatment strategies.
影响因子：
--
作者：
KESSLER, RC;SONNEGA, A;NELSON, CB
通讯作者：
NELSON, CB
影响因子：
120.7
作者：
Kessler, RC;Berglund, P;Wang, PS
通讯作者：
Wang, PS