PMH6 Healthcare Costs Increase Substantially Following Adjunctive Therapy Among MDD Patients on Antidepressant Monotherapy

Abstract

BACKGROUND Among patients with major depressive disorder (MDD), inadequate response to antidepressant monotherapy (ADT) is often followed by adjunctive pharmacotherapy or psychotherapy. Little is known about changes in costs following adjunctive therapy. To estimate changes in MDD-specific and all-cause healthcare costs following adjunctive therapy. From a national sample of insurance claims licensed from Decision Resources Group, MDD patients on ADT and added adjunctive therapy between 7/1/2014 and 12/31/2018 were identified. Eligible patients were on ADT for 8+ weeks preceding and following initiation of adjunctive therapy (index); and were stratified by insurance (Medicaid, commercial) and type of adjunctive therapy: “pharmacotherapy,” “psychotherapy,” or both (“dual adjunctive”). Costs were calculated for the six months pre- and post-index, changes in cost were annualized (PPPY) and standardized to 2019$. Pre-post significance testing was based on non-overlapping 95% confidence intervals. Following adjunctive therapy, annual all-cause healthcare costs increased by 2,213, $2,002, and $6,171 for commercially-insured pharmacotherapy (n=129,650), psychotherapy (n=20,037), and dual adjunctive (n=6,229), respectively. Pharmacotherapy patients realized significant increases in pharmacy ($1,129) and outpatient services ($932) and modest decreases ($231) in inpatient costs. Psychotherapy patients realized significant increases in office visits ($1,832) and decreases ($756) in inpatient costs. Dual adjunctive patients realized no decline in acute care costs, and increases in office visits ($2,335), outpatient services ($2,612), and pharmacy ($1,302). Among pharmacotherapy patients, MDD-specific pharmacy costs increased $526 and among psychotherapy patients, MDD-specific office visit costs increased $1,037. Among the 62,166 Medicaid-insured individuals (50,713 pharmacotherapy, 8,097 psychotherapy, and 3,356 dual adjunctive), total healthcare costs increased significantly more: $3,017 (pharmacotherapy); $3,005 (psychotherapy); $8,690 (dual adjunctive). Following adjunctive therapy, costs associated with office visits, outpatient services, and pharmacy increase substantially, and acute care services decrease only modestly. Total healthcare costs increase substantially for all MDD patients but substantially more for Medicaid-insured.