Trajectory analysis of healthcare costs for patients with major depressive disorder treated with high doses of duloxetine

Abstract

Objective:

To examine healthcare cost patterns prior to and following duloxetine initiation in patients with major depressive disorder (MDD), focusing on patients initiated at or titrated to high doses.

Research design and methods:

Retrospective analysis of 10,987 outpatients, aged 18–64 years, who were enrolled in health insurance for 6 months preceding and 12 months following duloxetine initiation.

Outcome measures:

Repeated measures and pre–post analyses were used to examine healthcare cost trajectories before and after initiation of low- (<60 mg/day), standard- (60 mg/day), and high-dose (>60 mg/day) duloxetine therapy. Decision tree analysis was used to identify patient characteristics that might explain heterogeneity in economic outcomes following titration to high-dose therapy.

Results:

Low-, standard-, and high-dose duloxetine were initiated for 29.6%, 60.9%, and 9.5% of patients, respectively. Within 6 months, 13.7% of patients had dose increases to > 60 mg/day. Regardless of dose, total costs increased prior to and decreased following initiation of treatment. The High Initial Dose Cohort had higher costs both prior to and throughout treatment compared to the other two cohorts. Following escalation to > 60 mg/day, higher medication costs were balanced by lower inpatient costs. Titration to high-dose therapy was cost-beneficial for patients with histories of a mental disorder in addition to MDD and higher prior medical costs.

Limitations:

Conclusions are limited by a lack of supporting clinical information and may not apply to patients who are not privately insured.

Conclusions:

In data taken from insured patients with MDD who were started on duloxetine in a clinical setting, healthcare costs increased prior to and decreased following initiation of therapy. Compared to patients initiated at low- and standard-doses, costs were greater prior to and following initiation for patients initiated at high doses. Increases in pharmacy costs associated with escalation to high-dose therapy were offset by reduced inpatient expenses.

Key words::

• Major depressive disorder
• Outcomes research
• Healthcare costs
• Duloxetine

Transparency

Declaration of funding

Financial support was provided by Eli Lilly and Company, Indianapolis, IN, USA. Employees of Lilly were involved in the study design, analysis of data, and in the decision to submit the manuscript for publication.

Declaration of financial/other relationships

At the time this manuscript was written, ZC, DF, YZ, DN, and XL were full-time employees of Eli Lilly and Company and/or one of its subsidiaries, and were minor stockholders of Eli Lilly and Company.

Acknowledgments

Appreciation is expressed to Tamara Ball, MD, for writing and editorial contributions. Dr Ball is a scientific writer employed full-time by i3 Statprobe, part of the inVentiv Health Company. Eli Lilly and Company contracted the technical writing of this manuscript with i3 Statprobe. Also acknowledged are: Steve Able and Wei Shen of Eli Lilly and Company for critical review of this manuscript, and Teri Tucker and Casey Brackney of i3 Statprobe for editorial review of this manuscript.