Symposium "Managed Care and Depression : Can Quality Be Assured ?". New York, NY, USA, 1996/05/05.
Herein we describe a retrospective intent-to-treat evaluation designed to compare the natural course of antidepressant utilization and direct health service expenditures for the treatment of a single episode of major depression among patients enrolled in a multistate network-model health maintenance organization and initially prescribed either a tricyclic antidepressant (amitriptyline or nortriptyline) or the serotonin selective reuptake inhibitor (SSRI) fluoxetine.
Patient-level paid-claims data for the period July 1,1988, through December 31,1991, were abstracted.
During the above time frame, fluoxetine was the only SSRI available in the United States.
Patients prescribed amitriptyline were more than three times as likely to require a change in antidepressant pharmacotherapy (OR=3.27,95% CI=2.31 to 5.49), while patients prescribed nortriptyline were nearly four times more likely to change medication (OR=3.82,95% CI=2.74 to 6.83) relative to patients initially prescribed fluoxetine.
Consistent with our intent-to-treat design, all accrued health service expenditures were assigned to the pharmacotherapeutic option initially prescribed.
Multivariate analyses revealed that initiation of antidepressant pharmacotherapy with amitriptyline resulted in a 25.7% increase in per capita depression-related health service expenditures per year, while initiation of antidepressant pharmacotherapy with nortriptyline resulted in a 28. (...)
Mots-clés Pascal : Etat dépressif, Chimiothérapie, Traitement, Nortriptyline, Amitriptyline, Etude comparative, Fluoxétine, Inhibiteur recapture, Sérotonine, Antidépresseur, Psychotrope, Analyse coût, Economie santé, Santé mentale, Homme, Composé tricyclique, Trouble humeur
Mots-clés Pascal anglais : Depression, Chemotherapy, Treatment, Nortriptyline, Amitriptyline, Comparative study, Fluoxetine, Reuptake inhibitor, Serotonin, Antidepressant agent, Psychotropic, Cost analysis, Health economy, Mental health, Human, Tricyclic compound, Mood disorder
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Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0211060
Code Inist : 002B02B02. Création : 11/09/1998.