OBJECTIVES: While antidepressant medications constitute the mainstay of pharmacologic management of MDD, patients with poor response are sometimes treated adjunctively with SGAs, such as aripiprazole, quetiapine, and olanzapine.  This study estimated healthcare utilization and costs among patients with MDD initiating adjunctive therapy with SGAs, using a large US healthcare claims database. METHODS: Adult patients receiving oral SGAs between 2009 and 2011 without evidence of schizophrenia or bipolar disorder were identified in the Truven MedStat MarketScan® Commercial Claims and Encounters and Medicare Supplemental and Coordination of Benefits Database.  The “index date” was defined as the date of first receipt of an SGA.  Patients with enrollment gaps during the 12-month period before the index date (pre-index period) or after the index date (follow-up period), no diagnosis of MDD during the pre-index period, no evidence of antidepressant medications overlapping their index date, or evidence of SGA prescriptions during the pre-index period were excluded.  Healthcare utilization and costs were examined over the pre-index and follow-up periods.  Healthcare encounters with diagnoses of MDD (ICD-9-CM 296.2, 296.3), and SGA and antidepressant prescriptions were designated “MDD-related”.

RESULTS: A total of 17,697 patients met study criteria. The most frequently prescribed SGA was aripiprazole (56.3%), followed by quetiapine (34.3%), risperidone (13.4%), and olanzapine (7.8%).  During the pre-index and follow-up periods, 27% and 7.5% of patients, respectively, were hospitalized for MDD (p<.0001), 37% and 20% were hospitalized for any reason (p<.0001), and 37% and 31% had ≥1 emergency department (ED) visits (p<.0001).  Mean MDD-related total health care costs during the pre-index and follow-up periods were $5427 vs $6222, respectively (p<0.0001).  The average cost of SGAs during follow-up was $2154.

CONCLUSIONS: Initiation of adjunctive therapy with SGAs in MDD patients is associated with a lower incidence of hospitalization (MDD-related and all-cause) and ED visits.