Abstract
Objectives: To examine health outcomes associated with adherence to Healthcare Effectiveness Data and Information Set (HEDIS) antidepressant medication management (AMM) during acute and continuation phases of depression treatment among older adults with dementia and major depressive disorder (MDD). Design: Retrospective cohort study. Setting: Medicare 5% sample data (2011–2013). Participants: Older adults (aged 65 years or older) with dementia and MDD. Measurements: The first antidepressant prescription claim from 1 May 2011 through 30 April 2012 was considered the index prescription start date (IPSD). Adherence during acute- and continuation-phase AMM was based on HEDIS guidelines. Study outcomes included all-cause mortality, all-cause hospitalization, and falls/factures (with mortality being the competing event for hospitalization and falls/fractures) during follow-up from end of acute-/continuation-phase AMM adherence. Due to the proportionality assumption violation of Cox models, fully non-parametric approaches (Kaplan–Meier and modified Gray’s test) were used for time-to-event analysis adjusting for the inverse probability of treatment weights. Results: Final study samples consisted of 4330 (adherent (N) = 3114 (71.92%)) and 3941 (adherent (N) = 2407 (61.08%)) older adults with dementia and MDD during acute- and continuation-phase treatments, respectively. No significant difference (p > 0.05) between adherent and non-adherent groups was observed for all-cause mortality and falls/fractures in both the acute and continuation phases. There was a significant difference in time to all-cause hospitalization during acute-phase treatment (p = 0.018), with median times of 530 (95% CI: 499–587) and 425 (95% CI: 364–492) days for adherent and non-adherent groups, respectively. Conclusions: Acute-phase adherence to HEDIS AMM was associated with reductions in all-cause hospitalization risk among older adults with dementia and MDD.
Highlights
Dementia is a public health priority with a substantial economic burden and is associated with several neuropsychiatric comorbidities, depression being the most common [1,2]
We examined the association of real-world outcomes with adherence to antidepressant therapy during acute and continuation phases of depression treatment using a nationally representative sample of United States (U.S.) older adults with dementia and newly diagnosed major depressive disorder (MDD)
Medicare beneficiaries were excluded from the final study sample if they (i) died during the 114 days post-index prescription start date (IPSD) or during the 231 days post-IPSD; (ii) were enrolled in Health Maintenance Organizations during baseline or during the respective post-IPSD acute- and continuous-phase treatment; (iii) had a fall or fracture during baseline; (iv) had a prescription for an inappropriate antidepressant during the 114 days post-IPSD or during the 231 days post-IPSD; (v) had end-stage renal disease (ESRD) any time during the calendar year of IPSD; (vi) were diagnosed with end-stage liver disease (ESLD) during baseline; or (vii) had missing race/ethnicity information
Summary
Dementia is a public health priority with a substantial economic burden (costs amounted to $290 billion in 2019) and is associated with several neuropsychiatric comorbidities, depression being the most common [1,2]. A meta-analysis published in 2018 investigated the efficacy and safety of antidepressants for patients diagnosed with dementia and showed little to no improvements in depression rating scale scores [10]. These mixed findings emphasize the need to conduct a comprehensive study exploring the effects of antidepressant treatment on various healthcare outcomes among older adults with concurrent dementia and depression. Our previous study [14] provides details regarding the potentially inappropriate antidepressant use in older adults
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