PATIENT-ASSIGNED HEALTH STATE UTILITIES FOR DEPRESSION-RELATED OUTCOMES - DIFFERENCES BY DEPRESSION SEVERITY AND ANTIDEPRESSANT MEDICATIONS

Background: Major depressive disorder is a prevalent psychiatric disor der in primary care associated with impaired patient functioning and w ell-being. We compared patient utilities for hypothetical depression-r elated and current health states and to examine differences in utiliti es by patient demographic and clinical characteristics. Methods: Seven ty patients with DSM-III-R major depressive disorder or dysthymia who completed at least 8 weeks of antidepressant treatment were recruited from primary care practices. Patients assessments included the Hamilto n Depression Rating Scale (HDRS), SF-36 Health Survey, and standard ga mble interviews to obtain utilities for 11 hypothetical depression-rel ated states, varying depression severity and antidepressant treatment, and the patient's current health state. Results: The mean utility for severe depression was 0.30 and 25% of patients rated this state as wo rse than or equivalent to death. Utilities varied from 0.55 to 0.63 fo r moderate depression, 0.64 to 0.73 for mild depression, and 0.72 to 0 .83 for antidepressant maintenance therapy. Statistically significant differences were observed in mean utilities by level of disease severi ty and by tricyclic antidepressants compared with the newer antidepres sants (i.e., fluoxetine, nefazodone). There were no significant differ ences in utilities for hypothetical states by demographic variables. M ean patient-assigned utilities for current health varied by depression severity and presence of medication side effects. Conclusions: Health state utility scores can be provided by patients with depression and the utility scores provided by patients for hypothetical states demons trate differences by disease severity and antidepressant treatment. Li mitations: The sample size was small which may limit generalizability and statistical power for detecting important differences. The study f indings are limited to patients who have successfully completed 8 week s of antidepressant treatment. Clinical Relevance: Understanding patie nt preferences for depression outcomes is important for economic evalu ations of new antidepressants and for understanding patient behavior a nd adherence to antidepressant treatment regimens. (C) 1998 Elsevier S cience B.V.