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Economic impact of non-persistence to antidepressant therapy in the Quebec community-dwelling elderly population.
J Affect Disord. 2009 May; 115(1-2):160-6.JA

Abstract

BACKGROUND

In a real-life setting, differences across newer antidepressants in patterns of use remain poorly explored, particularly in the older patients despite the high prevalence of late-life depression.

METHODS

An observational retrospective cohort study was conducted in the community-dwelling elderly population of Quebec using health databases to compare the newer antidepressants with respect to non-persistence, associated health care costs and cost/persistence ratio. A random sample of 12,825 outpatients who initiated an antidepressant treatment in 2000 were followed for 12 months. Non-persistence was defined as treatment duration of less than 180 days. Economic variables included direct costs of prescribed medications, medical services and hospitalizations assessed through RAMQ claims databases and Med-Echo hospitalization database. Cost/persistence ratio and incremental cost/persistence ratio were obtained for each antidepressant product; persistence being considered as an indicator of effectiveness.

RESULTS

55.6% of antidepressant treatments were non-persistent. Products associated with low antidepressant costs were often associated with high costs of other medications and health care services, and vice versa. Paroxetine was associated with the lowest non-persistence (50.5%; 95%CI 48.5-52.5) and one of the most favourable cost/persistence ratios (CDN$4869 per persistent treatment). Fluoxetine was associated with the most favourable incremental cost/persistence ratio.

LIMITATIONS

Some services and hospitalizations are not included in the administrative databases. No data on indication for treatment were available. These were likely to be non-differential across newer antidepressants.

CONCLUSION

As found in other populations, non-persistence with antidepressant treatment is very frequent in the Quebec elderly population. Products associated with poor persistence result in increased health care costs. Hence, intervention programs aimed at improving persistence would optimize the use of health care resources and result in economic advantages.

Authors+Show Affiliations

Center for Clinical Epidemiology and Community Studies, SMBD Jewish General Hospital, Montreal, Quebec, Canada.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18694602

Citation

Tournier, Marie, et al. "Economic Impact of Non-persistence to Antidepressant Therapy in the Quebec Community-dwelling Elderly Population." Journal of Affective Disorders, vol. 115, no. 1-2, 2009, pp. 160-6.
Tournier M, Moride Y, Crott R, et al. Economic impact of non-persistence to antidepressant therapy in the Quebec community-dwelling elderly population. J Affect Disord. 2009;115(1-2):160-6.
Tournier, M., Moride, Y., Crott, R., du Fort, G. G., & Ducruet, T. (2009). Economic impact of non-persistence to antidepressant therapy in the Quebec community-dwelling elderly population. Journal of Affective Disorders, 115(1-2), 160-6. https://doi.org/10.1016/j.jad.2008.07.004
Tournier M, et al. Economic Impact of Non-persistence to Antidepressant Therapy in the Quebec Community-dwelling Elderly Population. J Affect Disord. 2009;115(1-2):160-6. PubMed PMID: 18694602.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Economic impact of non-persistence to antidepressant therapy in the Quebec community-dwelling elderly population. AU - Tournier,Marie, AU - Moride,Yola, AU - Crott,Ralph, AU - du Fort,Guillaume Galbaud, AU - Ducruet,Thierry, Y1 - 2008/08/09/ PY - 2008/03/18/received PY - 2008/06/27/revised PY - 2008/07/01/accepted PY - 2008/8/13/pubmed PY - 2009/6/26/medline PY - 2008/8/13/entrez SP - 160 EP - 6 JF - Journal of affective disorders JO - J Affect Disord VL - 115 IS - 1-2 N2 - BACKGROUND: In a real-life setting, differences across newer antidepressants in patterns of use remain poorly explored, particularly in the older patients despite the high prevalence of late-life depression. METHODS: An observational retrospective cohort study was conducted in the community-dwelling elderly population of Quebec using health databases to compare the newer antidepressants with respect to non-persistence, associated health care costs and cost/persistence ratio. A random sample of 12,825 outpatients who initiated an antidepressant treatment in 2000 were followed for 12 months. Non-persistence was defined as treatment duration of less than 180 days. Economic variables included direct costs of prescribed medications, medical services and hospitalizations assessed through RAMQ claims databases and Med-Echo hospitalization database. Cost/persistence ratio and incremental cost/persistence ratio were obtained for each antidepressant product; persistence being considered as an indicator of effectiveness. RESULTS: 55.6% of antidepressant treatments were non-persistent. Products associated with low antidepressant costs were often associated with high costs of other medications and health care services, and vice versa. Paroxetine was associated with the lowest non-persistence (50.5%; 95%CI 48.5-52.5) and one of the most favourable cost/persistence ratios (CDN$4869 per persistent treatment). Fluoxetine was associated with the most favourable incremental cost/persistence ratio. LIMITATIONS: Some services and hospitalizations are not included in the administrative databases. No data on indication for treatment were available. These were likely to be non-differential across newer antidepressants. CONCLUSION: As found in other populations, non-persistence with antidepressant treatment is very frequent in the Quebec elderly population. Products associated with poor persistence result in increased health care costs. Hence, intervention programs aimed at improving persistence would optimize the use of health care resources and result in economic advantages. SN - 1573-2517 UR - https://www.unboundmedicine.com/medline/citation/18694602/Economic_impact_of_non_persistence_to_antidepressant_therapy_in_the_Quebec_community_dwelling_elderly_population_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0165-0327(08)00286-3 DB - PRIME DP - Unbound Medicine ER -