这项研究旨在描述开始使用艾氯胺酮或常规疗法的难治性抑郁症(TRD)患者的特征。
从IBMMarketScan数据库中选择患有重度抑郁症(MDD)的成年人。一种基于索赔的算法识别出具有TRD证据的患者,定义为在最近的重度抑郁发作期间,在2个不同的抗抑郁药试验中,在适当的剂量和持续时间后开始新的抗抑郁药治疗。在2019年3月5日(TRD的esketamine批准日期)接受治疗的患者,如果他们新开始使用esketamine(索引日期),则被分类为esketamine队列,如果他们新开始电惊厥治疗(ECT),则被分类为TRD常规治疗队列,经颅磁刺激(TMS),或药物治疗(指数日期是治疗开始日期,优先考虑ECT,然后TMS,然后是药物抗抑郁治疗)。描述了治疗开始前6个月的患者特征。
艾氯胺酮队列包括246名患者(平均年龄,46.5岁;63.0%女性),TRD常规治疗队列包括104,164名患者(平均年龄,46.9岁;74.8%为女性;0.4%开始ECT,1.2%启动TMS)。在6个月的预索引中,在艾氯胺酮和TRD常规治疗队列中,77.6%和41.4%接受了心理治疗,82.9%和34.2%接受了精神科医生就诊,分别。在esketamine(91.9%)和TRD常规疗法(63.6%)队列中,大多数患者接受了MDD的门诊治疗;57.3%和21.0%在专门的精神卫生保健机构接受了护理。在艾氯胺酮和TRD常规治疗队列中,有81.3%和35.1%的患者MDD被归类为“重度”。在esketamine队列的12.2%和16.3%以及TRD常规治疗队列的8.2%和10.3%中,确定了与心理健康相关(MHR)住院和急诊科就诊。治疗开始前,34.6%和17.6%的艾氯胺酮和TRD常规治疗组接受了≥3种独特的抗抑郁药。在8.5%和3.6%的艾氯胺酮和TRD常规治疗组开始治疗前观察到自杀意念或行为。esketamine队列中每月平均全因医疗保健费用为2532美元(58.2%MHR);在TRD常规治疗队列中,费用为1873美元(32.4%MHR)。
在TRD患者中,那些相对于传统疗法开始使用艾氯胺酮的患者表现出更高的MDD严重程度,使用更多的MHR住院/急诊科服务和抗抑郁治疗,并导致较高的医疗保健费用6个月的治疗前开始。这些发现表明,早期使用更有效的治疗方法识别和治疗TRD患者的潜在益处,并应告知付款人考虑使用esketamine的覆盖范围。
This study aimed to characterize patients with treatment-resistant depression (TRD) initiating esketamine or conventional therapies.
Adults with major depressive disorder (MDD) were selected from the IBM MarketScan Databases. A claims-based algorithm identified patients with evidence of TRD, defined as initiation of a new antidepressant therapy after 2 different antidepressant trials of adequate dose and duration during the most recent major depressive episode. Patients receiving treatment on/after March 5, 2019 (esketamine approval date for TRD), were classified to the esketamine cohort if they newly initiated esketamine (index date) or to the TRD conventional therapies cohorts if they newly initiated electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), or pharmacologic therapies (index date was the therapy initiation date, prioritizing ECT, then TMS, then pharmacologic antidepressant therapies). Patient characteristics in the 6 months before therapy initiation were described.
The esketamine cohort included 246 patients (mean age, 46.5 years; 63.0% female), and the TRD conventional therapies cohorts included 104,164 patients (mean age, 46.9 years; 74.8% female; 0.4% initiated ECT, 1.2% initiated TMS). During the 6 months preindex, in the esketamine and TRD conventional therapies cohorts, 77.6% and 41.4% received psychotherapy and 82.9% and 34.2% had a psychiatrist visit, respectively. Most patients had outpatient care for MDD in the esketamine (91.9%) and TRD conventional therapies (63.6%) cohorts; 57.3% and 21.0% received care at specialized mental health care settings. MDD was classified as \"severe\" among 81.3% and 35.1% of patients in the esketamine and TRD conventional therapies cohorts . Preindex mental health-related (MHR) inpatient admissions and emergency department visits were identified in 12.2% and 16.3% of the esketamine cohort and in 8.2% and 10.3% of the TRD conventional therapies cohort. Before therapy initiation, 34.6% and 17.6% of the esketamine and TRD conventional therapies cohorts received ≥3 unique antidepressants. Suicidal ideation or behavior was observed in 8.5% and 3.6% of the esketamine and TRD conventional therapies cohorts pretherapy initiation. Mean monthly all-cause health care costs in the esketamine cohort were $2532 (58.2% MHR); in the TRD conventional therapies cohorts, costs were $1873 (32.4% MHR).
Among patients with TRD, those initiating esketamine relative to conventional therapies displayed higher MDD severity, used more MHR inpatient/emergency department services and antidepressant treatments, and incurred higher health care costs 6 months pretherapy initiation. These findings suggest potential benefits of identifying and treating patients with TRD earlier with more effective treatments and should inform payers in consideration of esketamine coverage.