Regardless of Insurance Coverage, New Research Shows Vast Majority of People with Depression Are Not Effectively Treated
27 May 2005 - 2:00AM
PR Newswire (US)
Regardless of Insurance Coverage, New Research Shows Vast Majority
of People with Depression Are Not Effectively Treated Better Access
Needed for Both Privately Insured and Medicaid Patients ATLANTA,
May 26 /PRNewswire-FirstCall/ -- More than 85 percent of both
privately insured and Medicaid patients with depression are not
being effectively treated, as defined by the National Committee for
Quality Assurance (NCQA), according to new data presented at the
annual meeting of the American Psychiatric Association. While both
sets of patients were receiving inadequate treatment in this study,
Medicaid claimants were less likely to be treated according to
practice guidelines. This population was nearly twice as likely to
be prescribed an antidepressant below the recommended dose (19
percent vs. 10 percent, respectively); less likely to stay on
medication for more than 60 days (39 percent vs. 55 percent,
respectively), the duration of time recommended for effective acute
treatment; and half as likely to have their antidepressant switched
or augmented (5 percent vs. 10 percent, respectively) when they did
not respond or tolerate their current dose or medication. According
to practice guidelines,(1) if a patient does not feel better after
two months of treatment, their physician should increase the dose,
switch medications or augment with a second medication or
psychotherapy to help patients achieve success. Complete resolution
of all depression symptoms is the goal of treatment. When symptoms
don't go away completely, patients can have difficulty getting well
and staying that way.(2) "Although patients in this study overcome
the first, and very difficult, hurdle of receiving help, the
treatment they received often wasn't adequate," said Rebecca
Robinson, MS, health outcomes researcher, Eli Lilly and Company.
"Healthcare providers need to follow through the continuum of care
to ensure adequate quality care is provided to these patients by
following treatment guidelines and giving patients access to
medications that will increase their chances of getting well and
staying well." Additional Study Highlights Medicaid patients scored
lower than those with private insurance on all three components of
the Antidepressant Medication Management (AMM) measures. Medicaid
patients were more than five times less likely to attend the three
recommended follow-up visits with their physician or mental health
professional (5 percent vs. 29 percent, respectively) in the
12-weeks following diagnosis and prescription of antidepressant
medication. They were also considerably less likely to receive
effective acute treatment after a new episode of depression (39
percent vs. 61 percent, respectively) or recommended continuation
care in the six months following the episode (22 percent vs. 44
percent, respectively). The one state that was similar to private
insurance had greater access to antidepressant medications. On
average, Medicaid claimants were younger, sicker, and more likely
to have capitated insurance plans, which includes an annual set
dollar limit on payment for health care services. Impact of
Depression on Society Major depressive disorder is the leading
cause of disability in the United States and results in more days
of disability than chronic medical conditions like heart disease,
hypertension, diabetes and lower back pain.(3) Depression costs the
United States more than $83 billion annually: more than $26 billion
in direct medical costs and approximately $57 billion in indirect
costs.(4) An estimated 16 percent of the costs of antidepressants
are associated with patients who were never adequately treated.(5)
Inadequate dose and duration of antidepressant treatment has been
reported to directly hinder treatment outcomes.(6) More than 200
million days of work are lost each year due to depressive disorders
and, on average, 55 percent of costs are absorbed by employers
because of absenteeism and lost work productivity.(7) The annual
cost of lost productive work time, excluding short- and long-term
disability costs, time among US workers with depression was $44
billion. Individuals with major depression consistently reported
the most lost productive work time when it co-occurred with pain,
weakness, or fatigue; gastrointestinal complaints, and sensory or
nerve impairment. Most of the costs were for reduced performance
while at work rather than absenteeism -- less than one third of
these workers reported use of antidepressants in the previous 12
months and treatment effectiveness was reported to be moderate.(8)
Methods The study included people with depression starting
antidepressant therapy including privately insured (n= 9,933) and
Medicaid claimants (n= 20,170) -- and were followed for 12 months
using MarketScan Commercial Claims and Encounter (Commercial) and
Medicaid data from the same three states. Those with prior
antidepressant use or diagnosis of schizophrenia, bipolar, and
psychoses were excluded. Treatment quality was monitored using NCQA
Antidepressant Medication Management measures (AMM) and
antidepressant utilization patterns. The three components of AMM
include optimal practitioner contact, effective acute phase
treatment and effective continuation phase treatment.
Antidepressant use patterns measured were early discontinuation,
late discontinuation, switch/augment and titration. About Eli Lilly
and Company Lilly, a leading innovation-driven corporation, is
developing a growing portfolio of first-in-class and best-in-class
pharmaceutical products by applying the latest research from its
own worldwide laboratories and from collaborations with eminent
scientific organizations. Headquartered in Indianapolis, Ind.,
Lilly provides answers -- through medicines and information -- for
some of the world's most urgent medical needs. Additional
information about Lilly is available at http://www.lilly.com/ .
P-LLY (1) Practice Guideline for the Treatment of Patients With
Major Depression, 2nd edition. (April, 2000):
http://www.psych.org/psych_pract/treatg/pg/Depression2e.book-7.cfm
- figure3 (2) Paykel ES, et al. Psychol Med. 1995;25(6):1171-1180.
(3) Druss, BG, Rosenheck RA, Sledge WH. Health and Disability Costs
of Depressive Illness in a Major US Corporation. American Journal
of Psychiatry, 157:8, 1274-1278. (4) The Numbers Count: Mental
Disorders in America. (5) Weilburg JB, Stafford RS, O'Leary KM,
Meigs JB, Finkelstein SN. Costs of antidepressant medications
associated with inadequate treatment. American Journal of Managed
Care, 2004. 10(6): p. 357-65. (6) Selecting an SSRI: Dosing and
compliance. J Clin Psychiatry Monograph 1999; 17: 34-36. (7)
Greenberg P, et al. The Economic Burden of Depressive Disorders in
the United States: How Did it Change Between 1990 and 2000? Journal
of Clinical Psychiatry 2003; 64:1465-1475. (8) Stewart WF, Ricci
JA, Chee E, Hahn SR, Morganstein D. Cost of Lost Productive Work
time among US workers with depression. JAMA 2003; 289:3135- 3144.
(Logo: http://www.newscom.com/cgi-bin/prnh/20031219/LLYLOGO )
http://www.newscom.com/cgi-bin/prnh/20031219/LLYLOGO DATASOURCE:
Eli Lilly and Company CONTACT: David Shaffer (US), +1-317-651-3710,
cell: +1-317-332-9303, or Jennifer Yoder (OUS), +1-317-433-3445,
cell: +1-317-332-3145, both of Eli Lilly and Company
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