Depression Disease Management Research Articles

Selective phosphodiesterase type-5 inhibitor treatment of serotonergic reuptake inhibitor antidepressant-associated sexual dysfunction: a review of diagnosis, treatment, and relevance.

Sexual dysfunction related to antidepressants, particularly serotonin reuptake inhibitors is a major cause of premature treatment discontinuation. This places patients at increased risk for recurrence, relapse, chronicity, and mortality (eg, suicide). The clinical assessment requires a comprehensive evaluation of sexual function, including libido, arousal, orgasm, and resolution prior to affective disorder, disturbances associated with the emergence of depression, and changes or dysfunctions associated with antidepressant treatment. Other factors to be included for evaluating sexual dysfunction include inquiry for concurrent medical conditions, somatic treatments, lifestyle risk factors, and response to antidepressants. Current treatment approaches to antidepressant-associated sexual dysfunction have relied on open-label reports, literature reviews, and clinical wisdom. Without double-blind, placebo-controlled studies to support them, too much non-evidence-based treatment may be offered to patients. Advances into nonadrenergic-noncholinergic novel signal transduction, specifically phosphodiesterase type-5 inhibitors, offer new opportunities for developing evidence-based treatments for this side effect and improving depression disease management outcomes.

Opportunities for depression disease management: a pharmacy benefit manager's experience.

Opportunities for depression disease management: a pharmacy benefit manager's experience.

Use of an Integrated Health Data Warehouse to Measure the Employer Costs of Five Chronic Disease States

Health data warehouses are being developed to integrate a wide variety of databases including personnel and medical claims (inpatient, outpatient, and pharmacy), disability, absenteeism, and health-risk appraisals. This exciting technology can be very helpful in the design, implementation, and evaluation of disease management programs. First Chicago NBD installed an integrated health data management computer system or data warehouse in 1987, linking direct and indirect costs relating to health and disability. While employers have traditionally focused on direct, out-of-pocket health-care costs, indirect costs related to decreased productivity such as absenteeism have gone largely unmeasured and unmanaged. We conducted a 3-year database analysis of the direct and indirect costs associated with five common chronic diseases: diabetes mellitus, hypertension, depression, asthma, and ulcers. Of all the diseases studied in the First Chicago NBD employee population, depression, for example, results in the highest direct and indirect costs. Based on this information, First Chicago initiated a depression disease management program in 1994, which decreased per-employee medical costs from $71 per covered employee in 1993 to $61 per covered employee in 1995. During this period of time, inpatient costs for depression significantly declined, while outpatient costs increased and pharmacy benefit costs increased fourfold. Overall, medical plan costs for depression, hypertension, ulcer, asthma, and diabetes were $213, $71, $70, $48 and $35 paid per covered employee/retiree, respectively. This study of five relatively common diseases demonstrates that there are significant differences in the patterns of direct and indirect cost by disease state. It also demonstrates how data warehouses can enhance an organization's ability to measure disease state costs to assist in the implementation and evaluation of disease management strategies.