Methods for evaluating patient adherence to antidepressant therapy: a real-world comparison of adherence and economic outcomes.
OBJECTIVE
The objective of this study was to differentiate between 3 measures of antidepressant adherence with regard to the number of patients deemed adherent to therapy and the association between adherence and resource utilization.


METHODS
The authors conducted a retrospective study of patients initiating selective serotonin reuptake inhibitor (SSRI) therapy for depression and/or anxiety between July 2001 and June 2002 in a large national managed care database.


METHODS
Rates of 6-month SSRI adherence were measured by 3 different metrics: length of therapy (LOT), medication possession ratio (MPR), and combined MPR/LOT. Differences in resource utilization for each adherence metric were measured for patients deemed as 1) adherent, 2) nonadherent, 3) therapy changers, and 4) dose titraters.


RESULTS
There were 22,947 patients meeting study criteria. Although statistically different, 6-month adherence rates were numerically similar across all methods (LOT, 44.6%; MPR, 43.3%; and MPR/LOT, 42.9%, P < 0.001); approximately 57% of patients were nonadherent to therapy. Regardless of metric, the adherent cohort incurred the lowest yearly medical costs, followed by the nonadherent, titrate, and therapy change cohorts (P < 0.001 between adherent cohort and all other cohorts). The LOT method produced the greatest difference in yearly medical costs between adherent and nonadherent patients (Dollars 511) followed by MPR/LOT (Dollars 432) and MPR (Dollars 423). When antidepressant prescription costs were added to medical costs, patients requiring a therapy change and titrating therapy incurred higher costs than adherent patients, whereas nonadherent and adherent patients incurred similar costs.


CONCLUSIONS
Regardless of adherence metric, approximately 43% of patients were adherent to antidepressant therapy, and adherent patients were associated with the lowest yearly medical costs.
Cantrell
Christopher Ron
CR
GlaxoSmithKline, Research Triangle Park, North Carolina, USA.
Eaddy
Michael T
MT
Shah
Manan B
MB
Regan
Timothy S
TS
Sokol
Michael C
MC
D000328:Adult; D018687:Antidepressive Agents, Second-Generation / Q000191:economics / Q000627:therapeutic use*; D001008:Anxiety Disorders / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D015331:Cohort Studies; D015897:Comorbidity; D003866:Depressive Disorder / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D017048:Health Care Costs; D006801:Humans; D008329:Managed Care Programs; D008605:Mental Health Services / Q000191:economics* / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care / Q000191:economics*; D010349:Patient Compliance / Q000706:statistics & numerical data*; D012107:Research Design; D012189:Retrospective Studies; D017367:Selective Serotonin Reuptake Inhibitors / Q000191:economics / Q000627:therapeutic use*; D014481:United States / Q000453:epidemiology
D018687:Antidepressive Agents, Second-Generation; D017367:Selective Serotonin Reuptake Inhibitors