Real-World Economic Outcomes of Brexpiprazole and Extended-Release Quetiapine Adjunctive Use in Major Depressive Disorder
Received 19 June 2019
Accepted for publication 8 November 2019
Published 4 December 2019 Volume 2019:11 Pages 741—755
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Professor Dean Smith
Arpamas Seetasith,1 Mallik Greene,2 Ann Hartry,3 Chakkarin Burudpakdee1
1Medical and Scientific Services, Real-World Evidence Solutions, IQVIA, Falls Church, VA 22042, USA; 2Health Economics and Outcomes Research, Otsuka Pharmaceutical Development And Commercialization, Inc., Princeton, NJ 08540, USA; 3Health Economics and Outcomes Research, Lundbeck, Deerfield, IL 60015, USA
Correspondence: Chakkarin Burudpakdee
IQVIA, 3110 Fairview Park Drive, Suite 400, Falls Church, VA 22042, USA
Tel +1 610 244 2025
Purpose: Major depressive disorder (MDD) is a chronic mental disorder with a substantial clinical and economic burden. Despite the efficacy of adjunctive atypical antipsychotics (AAP) for augmentation in patients with major depressive disorder (MDD) who failed first-line antidepressant therapy (ADT), little is known of the impact of AAP choices on healthcare resource use and costs in real-world practice. Therefore, this study compared real-world healthcare utilization and costs in patients with MDD treated with brexpiprazole or extended-release (XR) quetiapine as adjunctive treatment to ADT.
Patients and methods: Adults with MDD starting adjunctive treatment with brexpiprazole (n=844) or extended-release (XR) quetiapine (n=688) were identified in the adjudicated health plan claims data (07/2014 – 09/2016). Resource use and healthcare costs in the 6 months following treatment initiation were compared between non-matched populations, and between propensity score-matched groups, and by multivariable regression analyses.
Results: During follow-up, unadjusted all-cause hospitalization (6.6% vs 12.5%) and ED visits (17.0% vs 27.5%) were lower with brexpiprazole compared to quetiapine XR (both p<0.001). Brexpiprazole-treated patients had significantly lower mean medical costs (US$6,421 vs US$8,545, p=0.0123) but higher mean pharmacy costs (US$7,401 vs US$4,691, p<0.0001) than quetiapine XR-treated patients did. Total healthcare costs were not significantly different between the two cohorts. Propensity score-matched comparisons of 397 patients in each cohort showed no statistically significant difference in all-cause hospitalization, ED visits, and total healthcare costs; and significantly lower medical costs (US$5,719 vs US$8,602, p=0.0092) but higher pharmacy costs (US$7,091 vs US$5,091, p=0.0007) in brexpiprazole compared to quetiapine XR. In multivariable regressions, brexpiprazole was associated with 16.1% lower medical costs (p=0.0186) and 9.4% higher total healthcare costs (p=0.0463) as compared to quetiapine XR.
Conclusion: Significantly lower medical costs were observed in patients with MDD treated with brexpiprazole vs quetiapine XR.
Keywords: atypical antipsychotic agents, comparative effectiveness research, health care utilization, healthcare costs, propensity score matching
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