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Real-World Economic Outcomes of Brexpiprazole and Extended-Release Quetiapine Adjunctive Use in Major Depressive Disorder

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Real-World Economic Outcomes of Brexpiprazole and Extended-Release Quetiapine Adjunctive Use in Major Depressive Disorder ClinicoEconomics and Outcomes Research Dovepress open access to scientific and medical research Open Access Full Text Article ORIGINAL RESEARCH Real-World Economic Outcomes of Brexpiprazole and Extended-Release Quetiapine Adjunctive Use in Major Depressive Disorder This article was published in the following Dove Press journal: ClinicoEconomics and Outcomes Research Arpamas Seetasith 1 Purpose: Major depressive disorder (MDD) is a chronic mental disorder with a substantial Mallik Greene 2 clinical and economic burden. Despite the efficacy of adjunctive atypical antipsychotics Ann Hartry 3 (AAP) for augmentation in patients with major depressive disorder (MDD) who failed first- Chakkarin Burudpakdee 1 line antidepressant therapy (ADT), little is known of the impact of AAP choices on healthcare resource use and costs in real-world practice. Therefore, this study compared real- 1 fi Medical and Scienti c Services, Real- world healthcare utilization and costs in patients with MDD treated with brexpiprazole or World Evidence Solutions, IQVIA, Falls Church, VA 22042, USA; 2Health extended-release (XR) quetiapine as adjunctive treatment to ADT. Economics and Outcomes Research, Patients and methods: Adults with MDD starting adjunctive treatment with brexpiprazole Otsuka Pharmaceutical Development fi And Commercialization, Inc., Princeton, (n=844) or extended-release (XR) quetiapine (n=688) were identi ed in the adjudicated NJ 08540, USA; 3Health Economics and health plan claims data (07/2014 – 09/2016). Resource use and healthcare costs in the 6 Outcomes Research, Lundbeck, months following treatment initiation were compared between non-matched populations, and Deerfield, IL 60015, USA between propensity score-matched groups, and by multivariable regression analyses. Results: During follow-up, unadjusted all-cause hospitalization (6.6% vs 12.5%) and ED visits (17.0% vs 27.5%) were lower with brexpiprazole compared to quetiapine XR (both p<0.001). Brexpiprazole-treated patients had significantly lower mean medical costs (US $6,421 vs US$8,545, p=0.0123) but higher mean pharmacy costs (US$7,401 vs US$4,691, p<0.0001) than quetiapine XR-treated patients did. Total healthcare costs were not signifi- cantly different between the two cohorts. Propensity score-matched comparisons of 397 patients in each cohort showed no statistically significant difference in all-cause hospitaliza- tion, ED visits, and total healthcare costs; and significantly lower medical costs (US$5,719 vs US$8,602, p=0.0092) but higher pharmacy costs (US$7,091 vs US$5,091, p=0.0007) in brexpiprazole compared to quetiapine XR. In multivariable regressions, brexpiprazole was associated with 16.1% lower medical costs (p=0.0186) and 9.4% higher total healthcare costs (p=0.0463) as compared to quetiapine XR. Conclusion: Significantly lower medical costs were observed in patients with MDD treated with brexpiprazole vs quetiapine XR. Keywords: atypical antipsychotic agents, comparative effectiveness research, health care utilization, healthcare costs, propensity score matching Introduction Major depressive disorder (MDD) is a chronic mood disorder that affects over Correspondence: Chakkarin 300 million people or 4.4% of the world’s population.1 In the United States (US), Burudpakdee IQVIA, 3110 Fairview Park Drive, Suite 16 million adults or 6.9% of the adult population had at least one major depressive 400, Falls Church, VA 22042, USA episode in 2012. The condition disproportionately affects female adults 35 years or Tel +1 610 244 2025 2,3 Email [email protected] older. MDD is a leading cause of the global disease burden in terms of disability, submit your manuscript | www.dovepress.com ClinicoEconomics and Outcomes Research 2019:11 741–755 741 DovePress © 2019 Seetasith et al. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms. – http://doi.org/10.2147/CEOR.S220007 php and incorporate the Creative Commons Attribution Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). Seetasith et al Dovepress measured in terms of years lived with disability and dis- treatment – within the first year of first antidepressant therapy ability-adjusted life years.4,5 In the US, MDD resulted in or within six months of evidence of inadequate therapy – is significant economic burden and almost 400 million dis- associated with significantly lower all-cause cost23 and greater ability days per year.2,6 In 2010, the incremental economic reduction in hospitalization and overall medical costs22 com- burden of individuals with MDD was estimated at US pared to delayed treatment. Three AAPs, including $210.5 billion, with 45%-47% attributable to direct costs, aripiprazole (2007), extended-release quetiapine (2009), and 2 and 48%-50% to workplace costs. brexpiprazole (2015), are approved by the FDA as an adjunc- Pharmacotherapy plays an important role in MDD. The tive treatment for MDD.24–26 Despite their efficacy, little is American Psychiatric Association recommends the use of known of the impact of AAP choices for the treatment of an antidepressant medication, such as a selective serotonin MDD on healthcare resource use and costs in real-world reuptake inhibitor (SSRI), serotonin-norepinephrine reup- practice. take inhibitor (SNRI), tricyclic or tetracyclic antidepressant, Brexpiprazole (Rexulti®) is a serotonin-dopamine activity or atypical antidepressant, as an initial treatment choice for modulator that is a partial agonist at 5-HT1A and dopamine patients with mild-to-moderate MDD.7 For patients with D2 receptor, and an antagonist at 5-HT2A and adrenergic severe MDD, the combination of psychotherapy and anti- 27,28 alpha1B/2C receptors, all at similar potency. The drug was depressant medication is recommended as an initial treat- recently approved in the US as adjunctive therapy to antide- ment of choice. For patients with minimal improvement pressant therapy (ADT) for the treatment of MDD and the after initial treatment, switching to an antidepressant from treatment of schizophrenia in 2015.26 Extended-release que- the same pharmacological class to one from a different class tiapine (Seroquel XR®) and its active metabolite, N-desalkyl or augmenting the antidepressant with other agents such as quetiapine (norquetiapine) are partial agonists at 5-HT ,and lithium, thyroid hormone or an atypical antipsychotic med- 1A antagonists at 5-HT ,5-HT ,dopamineD,histamineH, ication (AAP) has shown to be effective in improving 2A 2c 2 1 29 depressive symptoms.7 Results from STAR*D, a large clin- and adrenergic alpha1b receptors. The drug was approved in ical trial of 2,876 evaluable patients with at least moderate 2009 as adjunctive therapy to an antidepressant for the treat- depression, show that only one-third of patients experience ment of MDD and previously, for the treatment of schizophre- remissionwiththeirfirst antidepressant treatment, nia, manic or mixed episode bipolar I disorder, and depressive 25 citalopram.8–10 Among patients who did not achieve suffi- episode bipolar disorder. In this study, we described real- cient response and switched to a different antidepressant, world healthcare resource use and cost associated with adjunc- approximately 25% became symptom-free.8–10 The tive use of brexpiprazole in comparison to quetiapine XR in increased economic burden associated with inadequate patients with MDD. Brexpiprazole was selected because of its treatment response and an increasing number of unsuccess- recent approval for this indication while quetiapine XR was ful antidepressant trials,11–13 in addition to the limited selected as a comparator as it is a branded product that is FDA responses and low remission rates, highlight the unmet approved for indications similar to brexpiprazole. need for effective treatment in patients with inadequate response to initial antidepressant therapy. Materials and Methods Abundant evidence from prospective, controlled clinical trials supports the use of adjunctive treatment of antidepres- Database sants with AAPs, including olanzapine, risperidone, aripipra- This retrospective study utilized patient-level data from – zole, extended-release quetiapine, ziprasidone, lurasidone,14 IQVIA Real-World Data US Adjudicated Claims (for- and the recently approved drug, brexpiprazole,15 for patients merly known as PharMetrics Plus) between July 2014 and with MDD.16,17 Multiple meta-analysis studies from published September 2016. The database contains adjudicated medi- clinical trials (up until 2010) also show that the use of adjunc- cal, and pharmacy claims for more than 150 million unique tive AAPs was significantly more effective than placebo or enrollees from approximately 60 health plans across the US antidepressant therapy alone in terms of achieving remission and are representative of the US commercially insured or clinical response.18–21 Use of adjunctive AAP in patients population based on age and sex. Data are de-identified with MDD also shows significant reductions in all-cause, and and comply with the Health Insurance Portability and MDD-related hospitalizations and ED visits despite increases Accountability Act (HIPAA).
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