The Impact of Depression and Use of Anti-Depressants on Healthcare Resource Utilization (HCRU) in Multiple Myeloma (MM) Patients

Abstract

ObjectivesDepression and the use of anti-depressants are common co-existing morbidities often encountered by MM patients. Depression among MM patients is estimated at 30-50% versus 7% in the general population (Li HH et al; Blood, 2016).While approximately 11% of the general population >=12 years use antidepressants, the frequency of use in MM patients suffering from depression is unknown. We aimed to better understand real-world frequency of antidepressant use in MM patients in the contemporary era and how their use potentially impacts healthcare resource use (HCRU).MethodsNewly diagnosed MM patients initiating therapy between 01/01/2013-09/30/2016 were selected from the Inovalon Medical Outcomes Research for Effectiveness and Economics (MORE²) Registry payer claims and remittance dataset containing longitudinal information for 125 million unique covered patient lives, including more than 6 million cancer patients. Depression was ascertained using a combination of ICD9/10-CM, CPT, and HCPCS codes appropriate for behavioral health visits. Antidepressants were identified using National Drug Codes (NDC). Only patients with a diagnosis of depression following the onset of MM treatment were included in this analysis. Patients initiating antidepressants following a depression event (cases) were separated from patients never initiating antidepressants (controls). HCRU was measured from the diagnosis date of depression until the date of last claim and was measured per-patient per-month (PPPM). Patients with polyneuropathy between MM treatment and the medication onset were excluded using ICD9/10-CM codes as antidepressants are sometimes used to treat polyneuropathy. Patients having depression one year prior to initiating MM treatment were also excluded. Patients on anti-depressants were compared to patients never initiating anti-depressants across cost and utilization measures for inpatient, outpatient, office, and ER. P-values for categorical variables were generated using chi-square tests. P-values for continuous variables were calculated using Wilcoxon rank sum test since HCRU measures are often non-normally distributed.ResultsA total of 2,538 MM patients met our inclusion criteria. Depression was diagnosed in 565 patients (22.2%) after beginning a MM treatment. Of these, 129 patients (22.8%) received antidepressants (cases) and 443 patients (78.4%) did not (controls). The average length of follow-up in this cohort was 459.1 days (SD: 331.6). The most common medications prescribed were Sertraline (16.7%), Mirtazapine (15.1%), Duloxetine (12.9%), and Trazodone (12.9%). Compared to controls, cases experienced significantly shorter inpatient stays (mean: 5.02 vs 3.81 for case and control respectively, p-value 0.009). This resulted in lower, but not statistically significant, mean inpatient costs PPPM ($970.58 vs $1873.36). Both groups were otherwise comparable across other cost and utilization outcomes.ConclusionsDespite 22.2% of MM patients having depression diagnosis post-MM onset, only 22.8% of these patients with depression initiated anti-depressant therapy, resulting in an overall use of 5% of MM patients starting treatment. This is substantially lower than the 11% observed in the general population. The use of antidepressants in this context resulted in a favorable impact on HCRU and underscores the unmet need of proper mental health treatment and education for patients with MM. DisclosuresFeinberg:Cardinal Health: Employment.