Ep. Armstrong, Analysis of antidepressant use through hierarchical disease analysis - Using a managed care administrative database, DIS MANAG H, 9(5), 2001, pp. 255-267
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.