title: Healthcare utilization and costs incurred by patients with major depression after being switched from escitalopram to another SSRI for non-medical reasons.
abstract: OBJECTIVE
  To compare healthcare utilization and costs for major depressive disorder (MDD) patients treated with escitalopram and who were switched to another SSRI for non-medical reasons versus those who did not switch.
  
  
  METHODS
  Patients were identified in the Ingenix Impact Database (2003-2006). The analysis group included patients who remained on escitalopram for ≥ 90 days and switched to another SSRI within 45 days of end of supply days for non-medical reasons; the control group included matched individuals who did not switch within 45 days. Switching for medical reasons was defined as switching within 7 days after having a hospitalization, an emergency room (ER) visit, or a psychotherapy visit. Outcomes (all-cause and MDD-related) were analyzed over 3 months and included use of hospital, ER, outpatient visits and professional services, and healthcare costs. Outcomes were compared between the two groups using descriptive statistics and regression analyses controlling for differences in baseline characteristics. Costs were inflation adjusted to 2006 US dollars.
  
  
  RESULTS
  The study included 2,805 matched pairs. Compared to controls, switchers had higher rates of all-cause and MDD-related hospitalizations (relative risk [RR] = 1.4 and 2.0, respectively) and all-cause and MDD-related ER visits (RR = 1.2 and 1.6, respectively, all p ≤ 0.05). Results from multivariate analyses show that switchers had higher medical costs (+$138), drug costs (+$149) and total healthcare costs (+$322) compared to patients in the control group (all p < 0.0001).
  
  
  CONCLUSIONS
  This study's limitations include its short observational period and definition of switching for non-medical reasons.
  
  
  CONCLUSIONS
  Patients who were switched to another SSRI for non-medical reasons after being stabilized on escitalopram used more resources and had higher healthcare costs within 3 months of switching than patients who did not switch.
authors.affiliation: Analysis Group, Inc., 111 Huntington Avenue, Boston, MA 02199, USA. ewu@analysisgroup.com
authors.forename: Eric Q
authors.initials: EQ
authors.lastname: Wu
authors.forename: Rym
authors.initials: R
authors.lastname: Ben-Hamadi
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Yu
authors.forename: Jackson
authors.initials: J
authors.lastname: Tang
authors.forename: M
authors.initials: M
authors.lastname: Haim Erder
authors.forename: Anjana
authors.initials: A
authors.lastname: Bose
mesh_terms: D000328:Adult; D018687:Antidepressive Agents, Second-Generation / Q000008:administration & dosage* / Q000627:therapeutic use; D015283:Citalopram / Q000008:administration & dosage* / Q000627:therapeutic use; D015897:Comorbidity; D003365:Costs and Cost Analysis; D003865:Major Depressive Disorder / Q000188:drug therapy*; D004363:Drug Utilization; D005260:Female; D006296:Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D008297:Male; D008329:Managed Care Programs / Q000706:statistics & numerical data; D008875:Middle Aged; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage* / Q000627:therapeutic use; D014481:United States
chemical_list: D018687:Antidepressive Agents, Second-Generation; D015283:Citalopram; D017367:Selective Serotonin Reuptake Inhibitors