Indemnity – a type of fee-for-service medical plan that reimburses the patient and/or provider as expenses are incurred
Indemnity – a type of fee-for-service medical plan that reimburses the patient and/or provider as expenses are incurred. had 8 unique diagnosed comorbid medical and psychiatric conditions (38.6% vs. 29.1%). The prior 6-month total health care costs were $1,731 higher for duloxetine than for venlafaxine XR and declined for both medications in the 6 months after treatment began. Logistic regression analysis revealed that 61% of duloxetine patients and 61% of venlafaxine XR patients were predictable from prior patient and treatment factors. Conclusions Patients with MDD treated with duloxetine tended to have a more complex and costly antecedent clinical presentation compared with venlafaxine XR patients, suggesting that physicians do not use the medications interchangeably. Background Selective serotonin-reuptake inhibitors (SSRIs) and serotonin norepinephrine-reuptake inhibitors (SNRIs) are mainstays in the pharmacologic management of major depressive disorder (MDD) in the United States . SSRIs, such as sertraline, paroxetine, fluoxetine, and escitalopram/citalopram, have been used for years. However, recent studies demonstrated that fewer than 30% of patients CREB-H with MDD experience remission with initial SSRI treatment, and approximately 33% of nonremitting patients fail to accept an alternative second treatment . Some clinical studies and meta-analyses suggest that SNRIs may be more effective than SSRIs in ameliorating depressive symptoms in some circumstances [3-5], in achieving greater remission rates [6,7], and in second-line use after poor initial treatment response [8,9]. Data based on analyses of clinical trials are inconsistent, however [10-14]. This study examines the differential real-world use and cost impact of the SNRIs duloxetine hydrochloride and venlafaxine hydrochloride extended release (venlafaxine XR) in the treatment of MDD. Both duloxetine and venlafaxine XR are SNRIs indicated for the treatment of MDD. Duloxetine and venlafaxine GSK2330672 XR have similar mechanisms of action, but duloxetine has a more balanced affinity for both serotonin and norepinephrine transporters, whereas venlafaxine has a higher affinity for serotonin than norepinephrine transporters [15,16]. Clinically, duloxetine has additional pain-related indications for peripheral diabetic neuropathic pain and fibromyalgia . These different pharmacologic and indication profiles may lead practicing physicians to target different types of patients with MDD for different SNRIs. Many factors may GSK2330672 be associated with psychiatrists’ selection of an antidepressant. In previous studies, considerations involved in the psychiatrist’s selection of an antidepressant included the presence of specific symptoms (52.3%), the presence of a comorbid psychiatric disorder (45.6%), previous treatment response (either positive [17.0%] or negative [25.9%]) , previous antidepressant use , and sex- and age-related differences . However, little is known about the demographic characteristics, comorbidities, prior medication uses, and health care cost implications of patients GSK2330672 initiated on treatment with duloxetine compared with venlafaxine XR. No known studies have compared factors that might predict treatment initiation with one SNRI or the other and the potential impact of differential selection. Consequently, we sought to examine associations of demographics, prior comorbidities, medication use, and treatment cost, with treatment initiation for the two SNRIs among patients with MDD, using a large US administrative claims database. This study addresses whether these two medications are essentially interchangeable in their actual patterns of use for patients who are depressed or are used more selectively for patients with different kinds of treatment histories, background characteristics, and presenting symptoms. Methods Data Source and Patient Selection A retrospective study was conducted using data extracted from a large nationwide US administrative claims database (PharMetrics Integrated Outcomes Database) dating from July 2004 through July 2006. PharMetrics data represent more than 70 different managed-care organizations across the United States and more than 58 million commercially insured patients. The PharMetrics database is Health Insurance Portability and Accountability Act (HIPAA) compliant, de-identified, commercially available to the public, and widely considered exempt from institutional review board (IRB)/ethics committee approval. Due to full data de-identification on the collected data, IRB approvals were neither needed nor sought. The data encompasses comprehensive records on member demographic characteristics, health plan enrollment, inpatient and outpatient services, and prescriptions. Diagnostic and prescription data were extracted for 12 months before the date of treatment initiation with duloxetine or venlafaxine XR (index date), between July 1, 2005, and July 30,.