title: One-year costs of second-line therapies for depression.
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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Covance Health Economics and Outcomes Services Inc., Washington, DC 20005-3934, USA. erin.sullivan@covance.com
authors.forename: E M
authors.initials: EM
authors.lastname: Sullivan
authors.forename: R I
authors.initials: RI
authors.lastname: Griffiths
authors.forename: R G
authors.initials: RG
authors.lastname: Frank
authors.forename: M J
authors.initials: MJ
authors.lastname: Strauss
authors.forename: R J
authors.initials: RJ
authors.lastname: Herbert
authors.forename: J
authors.initials: J
authors.lastname: Clouse
authors.forename: H H
authors.initials: HH
authors.lastname: Goldman
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000191:economics* / Q000627:therapeutic use*; D000929:Antidepressive Agents, Tricyclic / Q000191:economics / Q000627:therapeutic use; D015331:Cohort Studies; D015897:Comorbidity; D003511:Cyclohexanols / Q000191:economics / Q000627:therapeutic use; D003866:Depressive Disorder / Q000188:drug therapy* / Q000191:economics; D016527:Drug Costs / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D005102:Health Expenditures / Q000706:statistics & numerical data; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007193:Independent Practice Associations / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D015999:Multivariate Analysis; D012189:Retrospective Studies; D017367:Selective Serotonin Reuptake Inhibitors / Q000191:economics / Q000627:therapeutic use; D000069470:Venlafaxine Hydrochloride
chemical_list: D000928:Antidepressive Agents; D000929:Antidepressive Agents, Tricyclic; D003511:Cyclohexanols; D017367:Selective Serotonin Reuptake Inhibitors; D000069470:Venlafaxine Hydrochloride