Association between timing of adjunctive brexpiprazole initiation and healthcare resource use and costs in major depressive disorder

To assess healthcare utilization and economic burden associated with use of brexpiprazole in adult patients with major depressive disorder (MDD) based on the timing of first dose administration following initiation of an antidepressant (ADT). A retrospective cohort study was conducted using Merative MarketScan commercial claims data to identify adult patients with MDD. The first brexpiprazole prescription was the index date and all-cause and MDD-specific healthcare resource use (HCRU) and costs were assessed in the 12-months post-index using regression modeling. Of the 1, 226 patients with MDD receiving brexpiprazole included in the analysis, 60. 0% initiated brexpiprazole ≥12 months post-ADT, 31. 1% initiated 2-12 months post-ADT and 9. 0% initiated within the first 2 months. Patients initiating brexpiprazole 2-12 months post-ADT or greater than 12-months post-ADT had 28% and 32% higher incidence of MDD-specific outpatient visits compared to those receiving brexpiprazole within the first 2 months. Incidence of MDD-related total visits was also significantly higher in patients initiating brexpiprazole 2-12 months (28%) or more than 12-months (33%) post-ADT. Patients initiating brexpiprazole 2-12 months post-ADT had higher MDD-specific outpatient (2, 911. 7 1, 950. 0 - 4, 347. 7 vs. 2, 132. 8 1, 338. 4 - 3, 398. 9; p = 0. 05) and total (3, 955. 3 2, 552. 7 - 6, 129. 1 vs. 2, 433. 5 1, 461. 5 - 4, 052. 1; p = 0. 006) costs than those initiating within the first 2 months. For those initiating brexpiprazole more than 12 months post-ADT, MDD-specific outpatient (3, 232. 5 2, 201. 3 - 4, 746. 2 vs. 2, 132. 8 1, 338. 4 - 3, 398. 9; p = 0. 006), inpatient (21, 394. 7 16, 807. 8 - 27, 236. 1 vs. 7, 161. 02, 806. 8 - 18, 269. 7; p = 0. 02) and total (4, 820. 8 3, 175. 1 - 7, 319. 5 vs. 2, 433. 51, 461. 5 - 4, 052. 1; p < 0. 001) costs were all higher than those initiating within 2 months. Limitations of this study are related to the inherent limitations of administrative claims database studies, including the potential for coding errors and the lack of clinical information. A longer duration of time to brexpiprazole initiation was associated with increased MDD-specific costs and a higher incidence of HCRU for most categories. Early intervention with adjunct brexpiprazole may reduce HCRU burden and cost among adults with MDD.