Analysis of antidepressant use through hierarchical disease analysis - Using a managed care administrative database

Objective: The purpose of this study was to evaluate the use of antidepress ants through use of mutually exclusive disease indications using a managed care database. Design and setting: A claims database from a 225 000 member managed care or ganisation was used for the study. A hierarchy of mutually exclusive antide pressant indications was developed: 'Depression', 'Other Approved Indicatio n', 'Mental Health', 'Surrogate Diagnosis', 'Other Uses', 'Chronic Disease' , and a residual 'Unclassified' hierarchical indication group. Main outcome measures and results: Patients in the Depression and Other App roved Indication hierarchical groups likely received the antidepressant dru gs primarily for these indications and frequently received selective seroto nin reuptake inhibitors (SSRIs). Use of antidepressants in the Mental Healt h Disorders hierarchical group may have been for a related disease. The pat ients in the Surrogate Diagnosis, Other Uses, Chronic Diseases, and Unclass ified hierarchical groups were significantly older than those patients in t he Depression group and tricyclic antidepressant (TCA) use was more frequen t than the SSRIs. The patients in the Unclassified diagnosis group may repr esent antidepressant use that is not adequately documented or not indicated . The Surrogate Diagnosis and Chronic Diseases hierarchical groups total he althcare costs were significantly higher than those observed in patients wi th a Depression diagnosis. Conclusions: Use of mutually exclusive hierarchical diagnosis groups proved to be a useful strategy for assessing antidepressant drug use. SSRI use wa s more common in the Depression and Other Approved Indication hierarchical groups. Patients in the Surrogate Diagnosis. Other Uses, Chronic Diseases, and Unclassified hierarchical groups used TCAs more frequently.