Author(s)
Teresa B. Gibson, PhD, Director, Research1, Yonghua Jing, PhD, Manager2, Jill Erin Bagalman, MSW, Senior Analyst3, Edward Kim, MD, MBA, Associate Director2, Wayne N Burton, MD, Associate Professor4, Ginger S Carls, MA, Senior Economist5, Quynh-Van Tran, PharmD, BCPP, Senior Manager, Medical Affairs OAPI6, Andrei Pikalov, MD, PhD, Senior Director6, Ron Z Goetzel, PhD, Research Professor, Vice President71Thomson Healthcare, Inc, Ann Arbor, MI, USA; 2 Bristol-Myers Squibb, Plainsboro, NJ, USA; 3 Thomson Reuters, WASHINGTON, DC, USA; 4 University of Illinois, Chicago, IL, USA; 5 Thomson Reuters, Ann Arbor, MI, USA; 6 Otsuka America Pharmaceutical, Inc, Rockville, MD, USA; 7 Emory University/Thomson Reuters, Washington, DC, USA
OBJECTIVES: Many patients with depression are not responsive to first-line treatment and undergo treatment switches and optimizations to discover a beneficial regimen (‘treatment-resistant' depression [TRD]). In addition to the patient burden, TRD is associated with significant economic costs. Challenges in treating patients with TRD are further complicated by the lack of a recognized definition of TRD. Using administrative data, we compare three claims-based methods (developed by Corey-Lisle, Crown and Russell) and a clinically-derived measure (MGH scale) of finding patients with TRD. METHODS: A retrospective study of patients aged 18–64 years with at least one antidepressant claim and employer-based coverage via large US firms. Patients had at least 2 years of continuous medical and prescription coverage in the MarketScan Database for 2000–2006 (n=106,139). TRD classification methods were replicated over a 24-month observation period. Kappa coefficients were used to assess agreement between dichotomous TRD measures. The relationship between continuous measures of TRD (based on the number of antidepressant switches and optimizations, and other metrics) and annual medical costs were also assessed. RESULTS: Over two thirds of patients (69.6%, n=73,872) were classified in a similar manner across all four methods: 10.7 % of patients (n=11,349) were found to have TRD, and the majority of patients (58.9%, n=62,515) did not have TRD. However, 30.4% of patients (n=32,252) were classified differently depending on the method. Kappa coefficients between pairs of methods ranged from 0.85% to 0.42%. As TRD severity increased, cost increased in an almost linear fashion. CONCLUSIONS: While patients with complex TRD are relatively easy to identify in health care administrative data, those with less complex TRD represent an opportunity for earlier recognition and intervention and associated potential cost savings. Dichotomous definitions of TRD may not be adequate; a gradient from moderate to complex TRD may be more useful for providers and insurers.
Conference/Value in Health Info
2009-05, ISPOR 2009, Orlando, FL, USA
Value in Health, Vol. 12, No. 3 (May 2009)
Code
PMH79
Topic
Health Service Delivery & Process of Care
Topic Subcategory
Hospital and Clinical Practices
Disease
Mental Health
