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Psych Congress  

Impact of Choice of Adjunctive Atypical Antipsychotic Treatment for Major Depressive Disorder on Treatment Persistence and Healthcare Costs in Patients with Comorbid Diabetes or Hyperlipidemia

Ruth Duffy, PhD
Susan Legacy, BS
Benjamin Gutierrez, PhD
Donna McMorrow, BS
Krishna Tangirala, MPH
Anna Eramo, MD
Francois-Xavier Lamy, BS
George Shrady, MS
Siddhesh Kamat, MS, MBA
Stephen Johnston, MA
Otsuka America Pharmaceutical, Inc

Atypical antipsychotics (AAs) are associated with increased metabolic risk; however, not all AAs have the same level of risk for metabolic adverse events (AEs). The aim of this retrospective database study was to compare nonpersistence with AA therapy (≥90-day gap between consecutive fills) and total healthcare costs in patients with ICD-9-CM diagnoses of both major depressive disorder (MDD) and diabetes or hyperlipidemia who were prescribed AAs associated with higher (diabetes: quetiapine, olanzapine and risperidone; hyperlipidemia: quetiapine and olanzapine) versus lower (diabetes: aripiprazole and ziprasidone; hyperlipidemia: aripiprazole, ziprasidone and risperidone) risks of metabolic AEs. The Truven Health MarketScan® Commercial Claims and Encounters Database was used to identify patients aged 18-64 years who, between 1/1/2007-12/31/2013, had been hospitalized for any reason prior to receiving adjunct MDD treatment with an AA. Prior hospitalization was used as a marker for high-risk health status. Of the 2,254 patients included in the study, 1,118 (49.6%) received AA treatments associated with a higher risk of metabolic AEs in the year following AA initiation. After adjusting for baseline differences in demographic and clinical characteristics using multivariate regression analyses, our results showed that patients receiving AAs with higher versus lower risks of metabolic AEs had a 27% higher likelihood of nonpersistence (P=.001) and 11% higher costs in total healthcare (P=.036). These results emphasize that when selecting an AA for use in patients with MDD, it is important to take into consideration any comorbidities present in order to both improve treatment persistence and reduce overall healthcare costs.

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