title: Comparative effectiveness in pain-related outcomes and health care utilizations between veterans with major depressive disorder treated with duloxetine and other antidepressants: a retrospective propensity score-matched comparison.
abstract: OBJECTIVE
  This study aimed to compare pain-related outcomes and health care utilization among patients with major depressive disorder (MDD) treated with duloxetine versus other antidepressants in the Veterans Health Administration (VHA).
  
  
  METHODS
  Patients initiating duloxetine or other antidepressants between October 1, 2005, and October 1, 2008 were extracted from the Veterans Integrated Service Network (VISN) 16 data warehouse. All patients included had at least 1 MDD diagnosis (ICD-9-CM: 296.2 or 296.3) and continuous eligibility in the 12 months prior to the initiation. Patients with prior diabetes (ICD-9-CM: 250.xx), schizophrenia (295.xx), or bipolar disorder (ICD-9-CM: 296.4x-296.8x) diagnosis were excluded. Duloxetine and nonduloxetine patients were matched via propensity scoring (1:1 ratio). Opioid use patterns, diagnosed substance abuse, self-reported pain score, and health care utilization over the 12-month postindex period were compared between cohorts.
  
  
  RESULTS
  Compared with duloxetine-treated patients (N = 439), nonduloxetine-treated patients (N = 439) during the postindex period had more opioid scripts (4.8 vs. 3.6, P = 0.002), longer use of opioid (133 vs. 100 days, P = 0.004), and a higher prevalence of substance abuse (41.00% vs. 23.69%, P < 0.001). Nonduloxetine-treated group had 12.0 more outpatient visits (41.8 vs. 29.8, P < 0.0001), 0.16 more hospital admissions (0.32 vs. 0.16, P = 0.001), and 2.36 more hospital days (3.37 vs. 1.01, P= 0.005). Additionally, nonduloxetine-treated patients were more likely to be hospitalized (17.8% vs. 10.9%, P = 0.004) over the postindex period.
  
  
  CONCLUSIONS
  Controlling for cross-cohort differences, veterans with MDD treated with duloxetine were associated with lower risks of opioid use and substance abuse and lower health care utilization than those treated with other antidepressants. ▪
authors.affiliation: School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA. lshi1@tulane.edu
authors.forename: Lizheng
authors.initials: L
authors.lastname: Shi
authors.forename: Jinan
authors.initials: J
authors.lastname: Liu
authors.forename: Yang
authors.initials: Y
authors.lastname: Zhao
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000700:Analgesics / Q000008:administration & dosage / Q000009:adverse effects; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D059350:Chronic Pain / Q000188:drug therapy* / Q000453:epidemiology* / Q000523:psychology; D015331:Cohort Studies; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000453:epidemiology* / Q000523:psychology; D000068736:Duloxetine Hydrochloride; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods; D012189:Retrospective Studies; D013876:Thiophenes / Q000008:administration & dosage* / Q000009:adverse effects; D014728:Veterans / Q000523:psychology; D055815:Young Adult
chemical_list: D000700:Analgesics; D000928:Antidepressive Agents; D013876:Thiophenes; D000068736:Duloxetine Hydrochloride