Using antidepressant drug data from a large claims database, strategies for detection and resolution of problems will be presented. Gaps between antidepressant prescription depletion and refill are not always due to non-compliance. Late refills are more likely than on-time refills to be followed by dose decreases, suggesting that some gaps may be attributable to verbal orders to reduce dosage by bisecting pills or taking fewer pills. Calculations of dose per calendar day from fill to refill can produce anomalous results because refill timing is related to arbitrary factors such as the weekday on which the prescription depletes. Using the entire therapeutic course to measure dose adequacy, or calculating dose per day of dispensed supply for each prescription, may produce more interpretable results.
Dose titration analyses produce different results, depending on the calculation method used.
A comparison of titration patterns for three antidepressant products, using five different methods, will be presented. The costs associated with treating a selected number of patients enrolled in a RCT will be very different from those incurred by patients generally. Medical claims data, have the advantage of generating cost estimates for large numbers of patients in a wide range of treatment settings nationwide. Compared to primary data collection, they also have the advantage of being relatively inexpensive. Together, these three data sources can be used to construct a composite measure of US health care costs for a given illness or treatment.