The use of atypical antipsychotics in patients with major depressive disorder who have not responded to antidepressant therapy substantially increased clinical response rates at 6 weeks; however the drugs are also much more costly, according to the results of an analysis published in the May issue of The Annals of Pharmacotherapy.
The use of atypical antipsychotics in patients with major depressive disorder (MDD) who have not responded to antidepressant therapy substantially increased clinical response rates at 6 weeks; however the drugs are also much more costly, according to the results of an analysis published in the May issue of The Annals of Pharmacotherapy.
“Major depressive disorder is a chronic and debilitating disease that affects approximately 13-14 million adults in the United States in any given year,” noted lead author Charu Taneja, MPH, senior research associate, Policy Analysis, Inc., Brookline, Mass., and colleagues. “Despite the availability of various antidepressants with established efficacy, up to 50% of patients with MDD fail to respond fully to antidepressant therapy of adequate dose and duration. Patients with inadequate response to antidepressant therapy have significantly higher costs of care.”
In addition, clinical trials of these drugs provide evidence of their clinical utility, but they do not address their comparative cost-effectiveness, the authors wrote.
As a result, the researchers sought to address this knowledge gap by conducting a decision analysis based on data from phase 3 clinical trials. They estimated expected outcomes and costs for patients with MDD who were receiving:
Aripiprazole 2 mg to 20 mg/day plus antidepressant therapy.
Quetiapine 150 mg/day or 300 mg/day plus antidepressant therapy,
A fixed-dose combination of olanzapine 6, 12, or 18 mg/day with fluoxetine 50 mg/day.
Antidepressant therapy alone.
The primary outcome of interest was clinical response at 6 weeks, at which point patients were assumed either responders or nonresponders.
Results of their analysis indicated that antidepressant monotherapy was estimated to increase clinical response rate by 30% at 6 weeks with an estimated cost of $192.
Adjunctive therapy was estimated to increase clinical response to 49% with aripiprazole (estimated cost $847), 34% with quetiapine 150 mg/day (estimated cost $541), 38% with quetiapine 300 mg/day (estimated cost $672), and 45% with olanzapine/fluoxetine (estimated cost $791).
Estimated costs per additional responder over a 6-week period (versus antidepressant therapy) were:
$3,447 for aripiprazole.
$8,725 for quetiapine 150 mg/day.
$6,000 for quetiapine 300 mg/day.
$3,993 for olanzapine/fluoxetine.
Although the authors noted a higher clinical response for aripiprazole, the cost of MDD-related care was also higher.
The short time frame of the study was a limitation, the authors noted, because patients considered nonresponders at 6 weeks may continue therapy to eventually achieve response and likewise, those who respond may continue adjunctive therapy longer-term.
Therefore, they concluded that although the results indicate a higher response rate with antipsychotics and a lower cost-per-additional responder for aripiprazole adjunctive therapy, further research is needed to examine the cost-effectiveness of adjunctive therapy over time and should focus on remission as a measure of effectiveness.
Coalition promotes important acetaminophen dosing reminders
November 18th 2014It may come as a surprise that each year Americans catch approximately 1 billion colds, and the Centers for Disease Control and Prevention estimates that as many as 20% get the flu. This cold and flu season, 7 in 10 patients will reach for an over-the-counter (OTC) medicine to treat their coughs, stuffy noses, and sniffles. It’s an important time of the year to remind patients to double check their medicine labels so they don’t double up on medicines containing acetaminophen.
Support consumer access to specialty medications through value-based insurance design
June 30th 2014The driving force behind consumer cost-sharing provisions for specialty medications is the acquisition cost and not clinical value. This appears to be true for almost all public and private health plans, says a new report from researchers at the University of Michigan Center for Value-Based Insurance Design (V-BID Center) and the National Pharmaceutical Council (NPC).
Management of antipsychotic medication polypharmacy
June 13th 2013Within our healthcare-driven society, the increase in the identification and diagnosis of mental illnesses has led to a proportional increase in the prescribing of psychotropic medications. The prevalence of mental illnesses and subsequent treatment approaches may employ monotherapy as first-line treatment, but in many cases the use of combination of therapy can occur, leading to polypharmacy.1 Polypharmacy can be defined in several ways but it generally recognized as the use of multiple medications by one patient and the most common definition is the concurrent use of five more medications. The presence of polyharmacy has the potential to contribute to non-compliance, drug-drug interactions, medication errors, adverse events, or poor quality of life.
Medical innovation improves outcomes
June 12th 2013I have been diagnosed with stage 4 cancer of the pancreas, a disease that’s long been considered not just incurable, but almost impossible to treat-a recalcitrant disease that some practitioners feel has given oncology a bad name. I was told my life would be measured in weeks.