Health care resource utilization and costs associated with switching versus augmenting antidepressant monotherapy in second-line treatment of major depressive disorder
Journal of Affective Disorders, 2025
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.
Authors
Masand PS, Nabulsi N, Laliberté F, Germain G, Klimek J, Kerolous M, Wade SW, Parikh M