Comparison of treatment persistence, hospital utilization and costs among major depressive disorder geriatric patients treated with escitalopram versus other SSRI/SNRI antidepressants

ABSTRACT

Objective: To assess treatment persistence, hospitalization outcomes and mean healthcare costs of geriatric major depressive disorder (MDD) patients treated with escitalopram compared to other selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs).

Research design and methods: Patients aged ≥65 years with at least one inpatient claim or two independent claims associated with MDD diagnosis were identified in the IHCIS National Managed Care Database (2003–2005). Patients were continuously enrolled for at least ≥12 months, filled at least one prescription for an SSRI/SNRI and did not use any second-generation antidepressant during the 6 months pre-index date. Unadjusted and multivariate analyses adjusting for baseline characteristics were conducted.

Main outcome measures: Treatment persistence, hospitalization utilization, and average prescription drug, medical, and total healthcare costs were compared between patients initiated on escitalopram versus other SSRI/SNRIs.

Results: Escitalopram-treated patients (N=459) were less likely to discontinue treatment (HR=0.85, p=0.012) or switch to another second-generation antidepressant (HR=0.76, p=0.006) compared to patients treated with other SSRI/SNRIs (N=1517). Escitalopram-treated patients had 39% fewer hospitalization days (p=0.004). Both groups had similar mean prescription drug costs ($1659 vs. $1630, p=0.687). After controlling for baseline characteristics, escitalopram-treated patients had lower mean total medical service costs ($9425 vs. $12703, p<0.001) and mean total healthcare costs ($11043 vs. $14163, p<0.001).

Limitations: This study's limitations include its small sample size, short observational periods and exclusivity of indirect costs.

Conclusions: Geriatric patients treated with escitalopram had higher treatment persistence, fewer hospitalization days and lower total healthcare costs than patients on other SSRI/SNRIs after controlling for baseline characteristics. Most of the cost savings were due to reductions in hospitalizations.