OBJECTIVES: To compare medication adherence, healthcare utilization and cost in MDD patients treated with AAP.

METHODS: Using Truven Health MarketScan® Commercial, Medicaid, and Medicare Supplemental databases, we identified adults with MDD initiating adjunctive treatment with brexpiprazole, quetiapine, or lurasidone (index AAP). We compared medication adherence and persistence measured by proportion of days covered (PDC) and treatment duration of index AAP, hospital care (hospitalization/ED), and medical costs (all-cause and psychiatric) during 6-month follow-up. Logistic and linear regression models were performed, adjusting for demographic, clinical, and utilization differences during the 6 months pre-index AAP.

RESULTS: Of 778 brexpiprazole, 626 lurasidone, and 3458 quetiapine initiators, mean (SD) PDC for index AAP was 0.60 (0.32), 0.56 (0.32), and 0.57 (0.33) (p=.027), respectively. Mean treatment duration was 102 (66.4), 92.4 (66.0), and 95.0 (66.6) days (p=.014), respectively. Brexpiprazole users had lowest unadjusted rates of all-cause (25.8% vs 34.2% for lurasidone, 37.6% for quetiapine, p<.001) and psychiatric (5.9% vs 7.7% for lurasidone, 11.2% for quetiapine, p<.001) hospital care. They also had lowest unadjusted all-cause [mean (SD) $8017 (17,328) vs $9449 (20,211) for lurasidone, $13,176 (32,158) for quetiapine, p<.001] and psychiatric [mean (SD) $2104 (9334) vs $3714 (11,371) for lurasidone, $4322 (15,398) for quetiapine, p<.001] medical costs. Adjusted rate (95% CI) of all-cause hospital care was lowest for brexpiprazole at 27.4% (24.0%-31.0%), vs 31.1% (27.3%-35.2%) for lurasidone, 35.3% (33.5%-37.1%) for quetiapine (p<.001). Adjusted psychiatric hospital care rates and costs (all-cause and psychiatric) did not differ across groups.

CONCLUSIONS: Adjunctive brexpiprazole users had statistically significantly better unadjusted medication adherence, as well as lower hospital care rates and costs than other AAP users. Adjusted overall hospital care rates remained statistically significantly different between brexpiprazole and other AAP users. Adjunctive AAP treatment choice may impact subsequent hospital care in patients with MDD.