title: Treatment persistence & health care costs of adult MDD patients treated with escitalopram vs. citalopram in a medicaid population.
abstract: OBJECTIVE
  Compare treatment persistence and health care costs of major depressive disorder (MDD) Medicaid patients treated with escitalopram versus citalopram.
  
  
  METHODS
  Retrospective analysis of Medicaid administrative claims data.
  
  
  METHODS
  Analyzed administrative claims data from the Florida Medicaid program (07/2002-06/2006) for patients ages 18-64 years with 21 inpatient claim or 2 independent medical claims for MDD. Outcomes included discontinuation and switching rates and prescription drug, medical, and total health care costs, all-cause and related to mental disorder. Contingency table analysis and survival analysis were used to compare outcomes between treatment groups, using both unadjusted analysis and multivariate analysis adjusting for baseline characteristics.
  
  
  RESULTS
  The study included 2,650 patients initiated on escitalopram and 630 patients initiated on citalopram. Patients treated with escitalopram were less likely to discontinue the index drug (63.7% vs. 68.9%, P=0.015) or to switch to another second-generation antidepressant (14.9% vs. 18.4%, P=0.029) over the six months post-index date. Patients treated with escitalopram had $1,014 lower total health care costs (P=0.032) and $519 lower health care costs related to mental disorder (P=0.023). More than half of the total cost difference was attributable to savings in inpatient hospitalizations related to mental disorder ($571, P=0.003) and to outpatient costs ($53, P<0.001). Escitalopram therapy was also associated with $736 lower medical costs related to mental disorder (P=0.009).
  
  
  CONCLUSIONS
  In the Florida Medicaid program, compared to adult MDD patients initiated on citalopram, escitalopram patients have better treatment persistence and lower total health care costs due to any cause and due to mental disorder, mostly driven by lower hospitalization costs related to mental disorder.
authors.affiliation: Analysis Group, Inc., 111 Huntington Avenue, Tenth Floor 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: Mei
authors.initials: M
authors.lastname: Lu
authors.forename: Nicolas
authors.initials: N
authors.lastname: Beaulieu
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Yu
authors.forename: M Haim
authors.initials: MH
authors.lastname: Erder
mesh_terms: D000328:Adult; D015283:Citalopram / Q000191:economics* / Q000627:therapeutic use; D015897:Comorbidity; D003362:Cost-Benefit Analysis; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000191:economics; D005260:Female; D005431:Florida; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D008484:Medicaid / Q000191:economics* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D017367:Selective Serotonin Reuptake Inhibitors / Q000191:economics / Q000627:therapeutic use; D016896:Treatment Outcome; D014481:United States
chemical_list: D015283:Citalopram; D017367:Selective Serotonin Reuptake Inhibitors