Hospital management and costs of antidepressant overdose: multicentre comparison of tricyclic antidepressants and selective serotonin reuptake inhibitors

SUMMARY

There is ongoing debate regarding the relative cost effectiveness of different classes of antidepressants, but there has been little consideration of the cost of deliberate self-poisoning. We examined the cost of antidepressant overdose at six hospitals over a 5 month period and found that the cost of selective serotonin reuptake inhibitor overdose was less than one-third that of tricyclic antidepressant overdose (mean cost per episode £173 versus £634). The cost of overdose is often ignored and should be considered in future analyses of the cost effectiveness of different classes of antidepressant.     

Clinical characteristics,pharmacotherapy, and healthcare resource use among patients with fibromyalgia newly prescribed pregabalin or tricyclic antidepressants

Abstract

Objective:

To examine treatment patterns and costs among patients with fibromyalgia prescribed pregabalin or tricyclic antidepressants (TCAs).

Methods:

Using the LifeLink? Health Plan Claims Database, patients with fibromyalgia (International Classification of Diseases, Ninth Revision, Clinical Modification code 729.1X) newly prescribed (index date) TCAs (n?=?898) were identified and propensity score-matched (PSM) with patients newly prescribed pregabalin (n?=?898). Pain-related pharmacotherapy, comorbidities, and healthcare resource use/costs were examined during the 12 months, pre-index, and follow-up periods.

Results:

Both patient groups reported multiple comorbidities and received pain medications in the pre-index and follow-up periods. Among patients prescribed pregabalin, use of non-selective non-steroidal anti-inflammatory drugs (43.3% vs 39.8%), other anticonvulsants (28.6% vs 23.3%), and tetracyclic/miscellaneous antidepressants (28.5% vs 25.8%) significantly decreased, and cyclooxygenase 2 (COX-2) inhibitors (7.7% vs 10.4%), TCAs (4.8% vs 7.9%), and topical agents (10.8% vs 15.1%) increased in the follow-up period (p?<?0.05). Among patients prescribed TCAs, there were significant decreases in muscle relaxants (42.0% vs 38.4%) and sedative hypnotics (27.4% vs 23.9%), and increases in COX-2 inhibitors (5.8% vs 7.9%) and anticonvulsants (25.1% vs 33.7%; p?<?0.05). There were increases (p?<?0.0001) in pharmacy costs in both cohorts and total healthcare costs in the pregabalin cohort from pre-index to follow-up. Median total costs were higher (p?<?0.05) in the pregabalin group vs TCAs in the pre-index ($9935 vs $8771) and follow-up ($10,689 vs $8379) periods.

Limitations:

Despite attempts to address bias through PSM, the higher pre-index costs in the pregabalin cohort suggest a channeling of patients with more severe fibromyalgia to pregabalin.

Conclusions:

Patients with fibromyalgia prescribed pregabalin or TCAs had multiple comorbidities and a sizeable pain medication burden, which increased in the follow-up period for both cohorts. Only 5% of pregabalin initiators had been treated with concomitant TCAs at baseline, suggesting that TCAs were inappropriate for these patients owing to their contraindications.     

The Social Reality of Depression: DTC Advertising of Antidepressants and Perceptions of the Prevalence and Lifetime Risk of Depression

This study is rooted in the research traditions of cultivation theory, construct accessibility, and availability heuristic. Based on a survey with 221 subjects, this study finds that familiarity with direct-to-consumer (DTC) print advertisements for antidepressant brands is associated with inflated perceptions of the prevalence and lifetime risk of depression. The study concludes that DTC advertising potentially has significant effects on perceptions of depression prevalence and risk. Interpersonal experiences with depression coupled with DTC advertising appear to significantly predict individuals’ perceived lifetime risk of depression. The study ultimately demonstrates that DTC advertising may play a role in constructing social reality of diseases and medicine. The findings strongly suggest that the social cognitive effects of DTC advertising are far-reaching, impacting pharmaceutical marketing strategy as well as presenting issues regarding public health and the business ethics of advertising drugs to consumers. Jin Seong Park is a doctoral student at the University of Florida in Gainesville. He earned his MA from Marquette University and BA from Korea University in Seoul, Korea. His research interests include health communication and DTC drug advertising, mood and heuristics in consumer information processing and judgments, and international advertising. Jean M. Grow is an assistant professor at Marquette University. She earned her PhD from University of Wisconsin-Madison and her BFA from the School of Art Institute of Chicago. Her scholarly work focuses on controversial advertising case studies. She has published extensively on Nike women's advertising, and her most recent scholarship focuses on DTC advertising of pharmaceuticals and public service announcements for Hepatitis C. In 2005, she coauthoured a book on creative strategy, Advertising Strategy: Creative Tactics from Outside/In (with T. Altstiel). Prior to joining the academy, she worked in the advertising industry with agencies such as DDB Needham, Foote Cone & Belding, J. Walter Thompson, and Leo Burnett.