EFFECT OF ANTIDEPRESSANT THERAPY ON HEALTH-CARE UTILIZATION AND COSTSIN PRIMARY-CARE

Objective: Four groups of patients receiving different antidepressant drugs in a primary care set-ring were compared in terms of duration of antidepressant therapy and health and mental health care utilization and costs. Methods: A retrospective analysis of tile medical and pharm acy claims of an employed population and their families nias conducted . A total of 1,242 patients with a diagnosis of depression were includ ed in the analyses. The four antidepressant cohorts were fluoxetine (N =799), trazodone (N=89), the tricyclics amitriptyline and imipramine ( N=104), and the secondary amine tricyclics desipramine and nortriptyli ne (N=250). The primary outcome measures were total health care charge s, total charges for mental health services, and the pattern of antide pressant use. Secondary measures included charges for outpatient care and pharmacy and the number of outpatient visits. Data analysis involv ed use of two-stage multivariate regression modeling known as sample s election models. Results: Patients taking fluoxetine achieved higher r ates of continuous use for at least sis months compared with those tak ing the other drugs. After selection bias due to observed and unobserv ed characteristics and other confounding variables was adjusted for, n o significant differences were found between drug cohorts in total med ical charges. Conclusions: Improvements in the process of care at no a pparent increase in total charges appear possible through appropriate medication therapy.