Dominick Esposito

Results of a Retrospective Claims Database Analysis of Differences in Antidepressant Treatment Persistence Associated With Escitalopram and Other Selective Serotonin Reuptake Inhibitors in the United States

BACKGROUND Although previous studies have found no differences in response to antidepressant pharmacotherapy between selective serotonin reuptake inhibitors (SSRIs), some recent trials suggest benefits associated with more rapid onset of action. OBJECTIVE The aim of this work was to compare the likelihood that patients initiating treatment with branded escitalopram, rather than with any of 3 SSRIs (ie, citalopram, fluoxetine, and paroxetine) that are available in generic or branded formulations, would continue therapy with the initial medication after 2 and 6 months. METHODS We used propensity score-weighted logistic regression to assess the effect of antidepressant choice on the likelihood of continuing treatment, based on data from a large administrative claims database with information about US patients. We modeled the propensity to initiate treatment with escitalopram based on demographic, diagnostic, insurance, and service-use characteristics in the 6 months before treatment initiation and used the results to calculate weights for analysis of treatment continuation. The primary outcome measures were receipt of 2 prescriptions of the index drug in the first 2 months and, among those continuing at 2 months, 4 prescriptions in the first 6 months. Antidepressant choice, cost, and service-use characteristics during the treatment period were included as covariates. Patients who initiated therapy between July 2002 and April 2005 were eligible for inclusion. RESULTS Based on data for 43,921 patients, at 2 months, escitalopram initiators were more likely to have continued initial medication than those receiving the other SSRIs (66.1% vs 61.9%, respectively; P < 0.01) and less likely to have switched or augmented treatment (4.8% vs 7.6%; P < 0.01). At 6 months, escitalopramtreated patients were also more likely to have continued initial medication (47.1% vs 41.0%; P < 0.01) and less likely to have switched or augmented treatment (9.4% vs 14.4%; P < 0.01). CONCLUSION Patients initiating treatment with escitalopram were more likely to continue and less likely to switch or augment treatment at 2 and 6 months of therapy compared with those who initiated with alternative SSRIs.

Out-of-Pocket Drug Costs and Drug Utilization Patterns of Postmenopausal Medicare Beneficiaries with Osteoporosis

BACKGROUND The Medicare Part D coverage gap has been associated with lower adherence and drug utilization and higher discontinuation. Because osteoporosis has a relatively high prevalence among Medicare-eligible postmenopausal women, we examined changes in utilization of osteoporosis medications during this coverage gap. OBJECTIVES The purpose of this study was to investigate changes in out-of-pocket (OOP) drug costs and utilization associated with the Medicare Part D coverage gap among postmenopausal beneficiaries with osteoporosis. METHODS This retrospective analysis of 2007 pharmacy claims focuses on postmenopausal female Medicare beneficiaries enrolled in full-, partial-, or no-gap exposure standard or Medicare Advantage prescription drug plans (PDPs), retiree drug subsidy (RDS) plans, or the low-income subsidy program. We compared beneficiaries with osteoporosis who were taking teriparatide (Eli Lilly and Company, Indianapolis, Indiana) (n = 5657) with matched samples of beneficiaries who were taking nonteriparatide osteoporosis medications (NTO; n = 16,971) or who had other chronic conditions (OCC; n = 16,971). We measured average monthly prescription drug fills and OOP costs, medication discontinuation, and skipping. RESULTS More than half the sample reached the coverage gap; OOP costs then rose for teriparatide users enrolled in partial- or full-gap exposure plans (increase of 121% and 186%;

Association Between Outpatient Visits Following Hospital Discharge and Readmissions Among Medicare Beneficiaries With Atrial Fibrillation and Other Chronic Conditions

300 and

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349) but fell for those in no-gap exposure PDPs or RDS plans (decrease of 49% and 30%;

Evaluating collaborations in comparative effectiveness research: opportunities and challenges for social network analysis

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Public perceptions of comparative effectiveness research and use of evidence in healthcare decision-making

40). OOP costs for beneficiaries in partial- or full-gap exposure PDPs increased >120% (increase of

Promising therapies, prohibitive costs: a qualitative assessment of the effects of the Medicare Part D doughnut hole on access to costly cancer medications

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The business case for pediatric asthma quality improvement in low-income populations: examining a provider-based pay-for-reporting intervention

176) in the NTO group and nearly doubled for the OCC group (increase of

Patients and clinicians as stakeholders in comparative effectiveness research: multiple perspectives and evolving roles.

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American Recovery and Reinvestment Act Investments in Data Infrastructure

151); these OOP costs were substantially lower than those for teriparatide users. Both teriparatide users and NTO group members discontinued or skipped medications more often than persons in the OCC group, regardless of plan or benefit design. CONCLUSION Medication discontinuation and OOP costs among beneficiaries with osteoporosis were highest for those enrolled in Part D plans with a coverage gap. Providers should be aware of potential cost-related nonadherence among Medicare beneficiaries taking osteoporosis medications.