Abstract
BackgroundThe aim of the study was to determine the most common treatment strategies and their costs for patients with an inadequate response to first-line antidepressant treatment (AD) in primary care.MethodA retrospective cohort study of medical records from six primary care centers was conducted. Adults with a major depressive disorder diagnosis, at least 8 weeks of AD treatment after the first prescription, and patient monitoring for 12 months were analyzed. Healthcare (direct cost) and non-healthcare costs (indirect costs; work productivity losses) were described.ResultsA total of 2,260 patients were studied. Forty-three percent of patients (N = 965) presented an inadequate response to treatment. Summarizing the different treatment approaches: 43.2% were switched to another AD, 15.5% were given an additional AD, AD dose was increased in 14.6%, and 26.7% remained with the same antidepressant agent. Healthcare/annual costs were 451.2 Euros for patients in remission vs. 826.1 Euros in those with inadequate response, and productivity losses were 991.4 versus 1,842.0 Euros, respectively (p < 0.001).ConclusionAntidepressant switch was the most common therapeutic approach performed by general practitioners in naturalistic practice. A delay in treatment change when no remission occurs and a significant heterogeneity in management of these patients were also found.
Highlights
The aim of the study was to determine the most common treatment strategies and their costs for patients with an inadequate response to first-line antidepressant treatment (AD) in primary care
Summarizing the different treatment approaches: 43.2% were switched to another AD, 15.5% were given an additional AD, AD dose was increased in 14.6%, and 26.7% remained with the same antidepressant agent
Forty-three percent of patients (N = 965; 95% confidence intervals (CI): 40.0%-46.4%) presented an inadequate response to firstline AD treatment
Summary
The aim of the study was to determine the most common treatment strategies and their costs for patients with an inadequate response to first-line antidepressant treatment (AD) in primary care. Major depressive disorder (MDD) is one of the most common mental diseases in the general population, with an estimated annual prevalence of 5.7% [1]. There is limited information on the referral rates to mental health care and referral criteria. In a study conducted in Spain, 23% of general practitioners (GPs) referred patients with major depression to the psychiatrist [11]. In a survey conducted by Villava and Caballero (2006) among more than 1,000 GPs in Spain, the mean referral rate was 24%, being higher in physicians who reported poorer training and greater demand for care [12]. The main reasons reported were severity of the episode (87%), lack of response to treatment (41%), and express request by the patient (37%)
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