Impact of Antidepressant Medication Adherence on Health Services Utilization and Cost
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The document summarizes a study on the impact of antidepressant medication adherence on health services utilization and costs. The study found that patients who adhered to their antidepressant medication had fewer inpatient hospital days but more emergency department and outpatient physician visits. Adherent patients also had lower total healthcare costs of $646 compared to non-adherent patients. The results suggest that programs to increase antidepressant medication use and adherence may reduce total healthcare costs for payers and employers.
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Impact of Antidepressant Medication Adherence on Health Services Utilization and Cost
- 1. Impact of Antidepressant Medication on Health Services Utilization and Cost M. Christopher Roebuck Director, Health Economics Western Economic Association International 84 th Annual Conference June 30, 2009
- 4. Extant Literature * Mental health drug costs only -$376 $378 ≥ 90 days of continuous therapy Eaddy -$39 — MPR≥80% Cantrell $1,070 $86 * No gap of 15+ therapy days Thompson -$976 $1584 MPR≥70% White CDN $19 $219 ≥ 180 days of continuous therapy Tournier Annual Total Healthcare Costs Annual Pharmacy Costs Adherence Measure Primary Author
- 8. Univariate Results 0.45 0.12 Quarterly Emergency Department Visits 9.77 1.79 Quarterly Inpatient Hospital Days 1.06 0.68 Charlson Index 0.19 0.04 Young Adult (Ages 18-24) 18.84 56.60 Male 0.48 0.34 Age 23,026 4,805 Quarterly Medical Costs 1,170 725 Quarterly Pharmacy Costs 2.68 2.34 Quarterly Outpatient Physician Visits 1.50 0.52 Quarterly Outpatient Hospital Visits 0.44 0.41 Medication Possession Ratio (MPR) 23,139 5,530 Quarterly Total Healthcare Costs 0.47 0.34 Optimally Adherent (MPR ≥ 0.80) S.D. Mean Variable
- 9. Bivariate Results: Health Services Utilization
- 10. Bivariate Results: Health Services Costs
Notas del editor
- In terms of direct health care costs, suicide costs, and workplace costs (reduced productivity), the national burden of depression was estimated at $26.1 billion annually in 2000 (Greenberg et al., 2003). Although this is an increase of 31% from the 1990 estimate ($19.9 billion), the per patient direct costs of treatment declined from approximately $4100 in 1990 to $3300 in 2000. This decrease has mainly been attributed to the use of less costly treatments and improved outreach, although other factors such as lower unemployment in 2000 and the introduction of selective serotonin reuptake inhibitors (SSRIs) may have contributed to improved well-being of individuals. With a greater proportion of patients suffering from depression, and receiving diagnosis and treatment (Greenberg et al., 2003), a natural question is whether greater savings can be achieved by increasing the use of and adherence to antidepressants among the diagnosed population. One study found 29% of diagnosed patients failed to pick up Rxs prescribed by their Although clinicians stress the need for adherence to depression therapy, evidence suggests that within 1 st month of treatment, about one half of patients discontinue antidepressant use. Research has confirmed that within other disease areas, particularly diabetes and dyslipidemia, improved adherence has markedly lowered total health costs (Sokol et al. 2005, others?), but in relation to depression, a consensus has not yet emerged.
- All studies were cross-sectional and most covered a time period of 12 months. Most considered a population of managed care or employer-insured patients (Cantrell, Eaddy, Thompson, White). Tournier studied an elderly population in Quebec. Measures of adherence varied as highlighted in the table. The results vary widely, partially depending on the adherence measures used, the populations studied, and the time period covered. Unobserved, individual-specific effects may be biasing the results, endogeneity from factors like the “healthy user effect” likely persist. That is, patients more likely to be adherent also more likely to engage in other healthy behaviors (e.g. diet, exercise, preventative physician visits). Note Brookhart et al study.