The treatment of unipolar major depression with psychotic features using combination therapy versus monotherapy : a study of adherence, persistence, health care utilization and expenditures, and medication-related adverse events

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dc.contributor.advisorRascati, Karen L.en
dc.contributor.committeeMemberFord, Kentya C.en
dc.contributor.committeeMemberRichards, Erika K.en
dc.contributor.committeeMemberWilson, James P.en
dc.contributor.committeeMemberBeretvas, Susan N.en
dc.creatorKim-Romo, Dawn Nicoleen
dc.creator.orcid0000-0002-9782-0747en
dc.date.accessioned2015-11-02T22:48:29Zen
dc.date.accessioned2018-01-22T22:28:48Z
dc.date.available2015-11-02T22:48:29Zen
dc.date.available2018-01-22T22:28:48Z
dc.date.issued2015-08en
dc.date.submittedAugust 2015en
dc.date.updated2015-11-02T22:48:29Zen
dc.descriptiontexten
dc.description.abstractThe purpose of the study was to assess medication adherence, medication persistence, suicide ideation/attempts, health care utilization and costs, and medication adverse events in Texas Medicaid patients with psychotic depression who utilized antidepressant monotherapy (AD cohort) or antidepressant plus second-generation antipsychotic therapy (AD/SGA cohort). Using prescription and medical records from September 2007 to December 2012, beneficiaries were included if they were aged 18-63 years, had no confounding psychiatric disorders, had a 6-month pre-index period with no antidepressants plus a 12-month post-index period, and had a diagnosis for unipolar major depressive disorder with psychotic features (ICD-9-CM 296.24 or 296.34). The index date was the first claim date for an antidepressant. All participants had at least two antidepressant claims, and those in the AD/SGA cohort also had at least two SGA claims. Study covariates included: age, race/ethnicity, gender, residence, Charlson Comorbidity Index score, tobacco use and/or dependence, and antidepressant persistence. A total of 926 participants met study criteria (AD cohort n=510; AD/SGA n=416). Overall, the mean age (±SD), Charlson Comorbidity Index score, and antidepressant persistence rate was 40.5 (±13.2) years, 0.6 (±1.3), and 172.3 (±130.4) days, respectively. The final sample included 66.8% females, 25.2% Caucasians, 34.9% African Americans, 36.7% Hispanics, 79.5% urban dwellers, and 19.7% with known tobacco use/dependence. The AD/SGA cohort had a 53% significantly higher likelihood of being adherent to antidepressant therapy, compared to the AD cohort (p=0.006). Similarly, the AD/SGA cohort had a 23% significantly lower hazard of antidepressant nonpersistence (based on persistence with a 45-day gap) (p=0.001). Alternatively, the AD cohort had a significantly lower rate of psychotic depression-related outpatient/emergency department visits (p<0.001), as well as significantly lower psychotic depression-related costs (medication, medical, and total) and all-cause medication costs (p<0.001). There were no differences in suicide ideation/attempts or rates of incident dyslipidemia or diabetes mellitus between cohorts. Evidence of incident extrapyramidal symptoms were rare (n=12). In conclusion, the AD/SGA cohort had better outcomes associated with antidepressant adherence and persistence, and the AD cohort had lower rates of health care utilization and costs. These real-world estimates should help increase the understanding of appropriate treatment for psychotic depression.en
dc.description.departmentPharmaceutical Sciencesen
dc.format.mimetypeapplication/pdfen
dc.identifierdoi:10.15781/T2MS6Ven
dc.identifier.urihttp://hdl.handle.net/2152/32171en
dc.language.isoenen
dc.subjectMajor depressive disorder with psychotic featuresen
dc.subjectPsychotic depressionen
dc.titleThe treatment of unipolar major depression with psychotic features using combination therapy versus monotherapy : a study of adherence, persistence, health care utilization and expenditures, and medication-related adverse eventsen
dc.typeThesisen

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