Retrospective analysis of the health-care costs of bupropion sustained release in comparison with other antidepressants.
OBJECTIVE
The objective of this study was to evaluate the health care costs associated with the treatment of a new episode of depression with bupropion sustained release (SR) rather than with other antidepressants (selective serotonin reuptake inhibitors [SSRIs], tricyclic antidepressants [TCAs], and serotonin norepinephrine reuptake inhibitors [SNRIs]).


METHODS
This was a retrospective cohort study based on the private-pay, fee-for-service 1997 and 1998 MEDSTAT MarketScan databases. Individuals were included if they were 18 years of age or older, had an initial prescription for an antidepressant under study with an index prescription date between July 1997 and June 1998, and had a claim for a diagnosis of depression diagnosis within 30 days of the index date. All patients' claims from six months before and after receiving their index antidepressant prescription were examined. Total, outpatient, and pharmacy costs were compared among antidepressant groups using an intent-to-treat analysis with exponential regression models and bootstrapped 95% confidence intervals.


RESULTS
A total of 1771 patients were included in the study cohort. The mean age was 41.6 years, and 69.5% of subjects were female. Most patients (75%) continued with the index antidepressant during the 6-month follow-up period. Although the drug acquisition cost was lowest for TCAs, total costs were significantly higher for patients treated with TCAs than for those treated with bupropion SR (p < .05). In comparison with bupropion SR, patients initiating therapy with sertraline had significantly higher mental health payments (p < .05).


CONCLUSIONS
Initiating treatment of depression with bupropion SR was associated with lower total mental health care costs compared with TCAs and with sertraline. This study reaffirms that formulary and medical decision-makers should consider the overall impact of antidepressant treatment, including but not limited to drug acquisition costs, other health care costs, and drug efficacy and safety.
Poret
A W
AW
GlaxoSmithKline, Health Outcomes Department, Research Triangle Park, NC, USA. Amy.white@medstat.com
Neslusan
C
C
Ricci
J F
JF
Wang
S
S
Khan
Z M
ZM
Kwong
J W
JW
D000293:Adolescent; D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000191:economics / Q000627:therapeutic use; D018687:Antidepressive Agents, Second-Generation / Q000191:economics* / Q000627:therapeutic use*; D000929:Antidepressive Agents, Tricyclic / Q000191:economics / Q000627:therapeutic use; D016642:Bupropion / Q000191:economics* / Q000627:therapeutic use*; D015331:Cohort Studies; D017281:Cost of Illness; D016208:Databases, Factual; D003866:Depressive Disorder / Q000188:drug therapy* / Q000191:economics*; D018765:Dopamine Uptake Inhibitors / Q000191:economics* / Q000627:therapeutic use*; D016527:Drug Costs / Q000706:statistics & numerical data; D018588:Fee-for-Service Plans; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D012189:Retrospective Studies; D017367:Selective Serotonin Reuptake Inhibitors / Q000191:economics / Q000627:therapeutic use; D016896:Treatment Outcome; D014481:United States
D000928:Antidepressive Agents; D018687:Antidepressive Agents, Second-Generation; D000929:Antidepressive Agents, Tricyclic; D016642:Bupropion; D018765:Dopamine Uptake Inhibitors; D017367:Selective Serotonin Reuptake Inhibitors