• Zhanglin Cui, Douglas E Faries, Yang Zhao, Diego Novick, and Xianchen Liu.
• Eli Lilly and Company, Indianapolis, IN, USA.
• J Med Econ. 2011 Jan 1;14(5):662-72.

ObjectiveTo examine healthcare cost patterns prior to and following duloxetine initiation in patients with major depressive disorder (MDD), focusing on patients initiated at or titrated to high doses.Research Design And MethodsRetrospective analysis of 10,987 outpatients, aged 18-64 years, who were enrolled in health insurance for 6 months preceding and 12 months following duloxetine initiation.Outcome MeasuresRepeated measures and pre-post analyses were used to examine healthcare cost trajectories before and after initiation of low- (<60 mg/day), standard- (60 mg/day), and high-dose (>60 mg/day) duloxetine therapy. Decision tree analysis was used to identify patient characteristics that might explain heterogeneity in economic outcomes following titration to high-dose therapy.ResultsLow-, standard-, and high-dose duloxetine were initiated for 29.6%, 60.9%, and 9.5% of patients, respectively. Within 6 months, 13.7% of patients had dose increases to > 60 mg/day. Regardless of dose, total costs increased prior to and decreased following initiation of treatment. The High Initial Dose Cohort had higher costs both prior to and throughout treatment compared to the other two cohorts. Following escalation to > 60 mg/day, higher medication costs were balanced by lower inpatient costs. Titration to high-dose therapy was cost-beneficial for patients with histories of a mental disorder in addition to MDD and higher prior medical costs.LimitationsConclusions are limited by a lack of supporting clinical information and may not apply to patients who are not privately insured.ConclusionsIn data taken from insured patients with MDD who were started on duloxetine in a clinical setting, healthcare costs increased prior to and decreased following initiation of therapy. Compared to patients initiated at low- and standard-doses, costs were greater prior to and following initiation for patients initiated at high doses. Increases in pharmacy costs associated with escalation to high-dose therapy were offset by reduced inpatient expenses.

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