The economic burden associated with SSRI treatment failure in a managed care population

OBJECTIVE: The objective of this study was to describe the economic burden to managed care associated with failure of selective serotonin reuptake inhibitor (SSRI) therapy in terms of direct medical costs. METHODS: A retrospective analysis of the PharMetrics database, a national managed care medical and pharmacy claims dataset of 1.9 million major depressive disorder patients between January 2003 and June 2005 was conducted. A pre-post comparison of annual medical cost increases following new SSRI treatment was performed and differences in mean cost increases for the SSRI-failure versus non-failure groups were calculated using t-tests and confirmed using multivariate linear regression. RESULTS: The percentage of subjects with likely SSRI treatment failure was 30.7% (n=2,595). The two groups were statistically similar (p>0.05) in age, gender distribution and insurance status. The mean increase in total direct medical costs was $6,489 versus $3,257 for the SSRI treatment failure and non-failure cohorts, respectively. The major components of these cost increases were outpatient cost ($2,579 vs. $1,309) and inpatient cost ($2,862 vs. $1,532), between the SSRI treatment failure and non-failure cohorts, respectively. All differences remained statistically significant at p<0.001, even after controlling for potential confounders. CONCLUSIONS: This descriptive study found that increased costs of major depressive disorder are substantial following the onset of a new SSRI treatment episode and significantly higher among patients with likely SSRI treatment failure.