Economic Burden, Treatment Utilization, and Medication Adherence of Post-Traumatic Stress Disorder (PTSD) Patients: A Retrospective Commercial and Medicare Part B Insurance Claims Analysis

OBJECTIVES: This retrospective study explored economic burden and treatment utilization associated with PTSD.

METHODS: Index date was assigned as the first PTSD claim. Observation periods were 1-year pre- and 2-year post-index (follow-up). Cases with only acute PTSD, cancer, or insurance gaps during the observational period were excluded. Severe PTSD (SP) and non-severe PTSD (NSP) cohorts were defined by the presence/absence of comorbid mental health conditions (major depression, bipolar disorder, schizophrenia) post-index. The no PTSD (NP) cohort included NSP cases with only one (index) PTSD claim and without labeled PTSD treatments. Study cohorts were propensity-score matched in a 1:1:1 ratio.

RESULTS: The matched sample included 5,076 patients (n=1,681 SP; n=1,681 NSP; n=1,714 NP) with $19,602 any-cause, $2,109 PTSD-related, and $1,818 anxiety-related total expenditures. SP patients had higher total costs than NSP and NP patients during follow-up (any-cause: $32,302 vs. $14,292 and $12,355; PTSD-related: $3,762 vs. $1,750 and $841; anxiety-related: $4,315 vs. $831 and $338; all p<0.001). Follow-up outpatient costs were numerically greater than inpatient and emergency department costs for any-cause ($9,650, $3,997, and $1,606, respectively) and PTSD-related services ($1,259, $733, and $118, respectively).

Psychotherapies, FDA-approved medications, and off-label medications were utilized by 52.8% (2,678/5,076), 12.9% (656/5,076), and 48.5% (2,460/5,076) of all patients, respectively. SP was more commonly treated than NSP and NP (psychotherapy: 84.5% [1,420/1,681] vs. 74.8% [1,258/1,681] and 0.0% [0/1,714]; FDA-approved medications: 26.1% [438/1,681] vs. 13.0% [218/1,681] and 0.0% [0/1,714]; off-label medications: 76.1% [1,279/1,681] vs. 38.7% [650/1,681] and 31.0% [531/1,714]; all p<0.001). FDA-approved medication adherence per proportion of days covered (PDC) was low (≤0.39) during follow-up without any between-cohort differences. Proportions of adherent PTSD patients (PDC≥0.80) were also low (highest rates: escitalopram, 17.5% [107/610]; sertraline, 17.1% [97/567]).

CONCLUSIONS: PTSD is associated with high expenditures and low medication adherence. The highest economic burden and treatment utilization were observed in patients with concomitant mental health comorbidities.