Health care resource utilization and costs associated with switching versus augmenting antidepressant monotherapy in second-line treatment of major depressive disorder

BACKGROUND: While augmenting and switching antidepressant monotherapy are reasonable second-line options for treating major depressive disorder (MDD), understanding the impact of these strategies beyond effectiveness may inform clinical decision-making. We evaluated health care resource utilization (HCRU) and costs of augmenting versus switching antidepressant monotherapy. METHODS: The Merative™ MarketScan® Commercial Database was used to identify adults who initiated first-line antidepressant monotherapy within 60 days of their first observed MDD diagnosis. Patients with ≥2 lines of therapy (LOTs) post-diagnosis were classified as switching or augmenting at the start of second LOT (index date). Rates of all-cause and mental health (MH)-related hospitalizations, emergency department (ED) visits, and outpatient hospital visits (per person-year [PPY]) and health care costs (per person per year [PPPY]) were compared between cohorts using inverse probability of treatment weighting. Rate ratios (RRs) were calculated from Poisson regression models for HCRU; cost differences were calculated from linear regression models. RESULTS: Of 156,703 eligible patients, 133,453 (85 %) switched therapies in their second LOT, and 23,250 (15 %) augmented. Baseline characteristics were similar between weighted cohorts. Rates of hospitalizations, ED visits, and outpatient hospital visits PPY were significantly lower in patients who augmented versus switched (all-cause RRs: 0.80, 0.90, and 0.94, respectively, all P < 0.001; MH-related RRs: 0.81, 0.83, and 0.85, respectively, P < 0.001). Augmenting was associated with significantly lower medical costs than switching ($11,263 vs $11,941 PPPY; mean difference: -$678, P = 0.009). LIMITATIONS: Claims database; generalizability to other insurance types. CONCLUSIONS: Augmenting MDD therapy rather than switching may reduce burdens on the health care system.