OBJECTIVE: Four groups of patients receiving different antidepressant
drugs in a primary care setting were compared in terms of duration of
antidepressant therapy and health and mental health care utilization and
costs. METHODS: A retrospective analysis of the medical and pharmacy claims
of an employed population and their families was conducted. A total of
1,242 patients with a diagnosis of depression were included in the
analyses. The four antidepressant cohorts were fluoxetine (N = 799),
trazodone (N = 89), the tricyclics amitriptyline and imipramine (N = 104),
and the secondary amine tricyclics desipramine and nortriptyline (N = 250).
The primary outcome measures were total health care charges, total charges
for mental health services, and the pattern of antidepressant use.
Secondary measures included charges for outpatient care and pharmacy and
the number of outpatient visits. Data analysis involved use of two-stage
multivariate regression modeling known as sample selection models. RESULTS:
Patients taking fluoxetine achieved higher rates of continuous use for at
least six months compared with those taking the other drugs. After
selection bias due to observed and unobserved characteristics and other
confounding variables was adjusted for, no significant differences were
found between drug cohorts in total medical charges. CONCLUSIONS:
Improvements in the process of care at no apparent increase in total
charges appear possible through appropriate medication therapy.