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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