Ralph Swindle

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Ralph Swindle PhD is a retired Research Health Services Psychologist. His career spanned clinical and evaluation research in Community Mental Health, VA Health Services Research, and Health Outcomes Research at Eli Lilly.

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Steven Pinker

Harvard University

Nicola Jane Holt

University of the West of England

Sharon Tettegah

University of California, Santa Barbara

John Johnson

Pennsylvania State University

Gina Alicea

University of Chicago

Caroline Howarth

London School of Economics and Political Science

Javier E. Jiménez Castillo

Universidad Católica Silva Henríquez

Thomas L Webb

The University of Sheffield

Asimina M Ralli

National and Kapodistrian University of Athens

Salim Vally

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Papers by Ralph Swindle

PMD23: Is Markov Chain/Decision Tree Approach Better Than Cost Function Approach in Modeling the Pharmaceutical Costs for Attention Deficit/Hyperactivity Disorder? An Empirical Study Based on a Large Claim Database

Value in Health, May 1, 2003

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The Cost of Comorbid Depression and Pain for Individuals Diagnosed With Generalized Anxiety Disorder

Journal of Nervous and Mental Disease, Feb 1, 2009

Patients with generalized anxiety disorder (GAD) often have comorbid medical and psychiatric diso... more Patients with generalized anxiety disorder (GAD) often have comorbid medical and psychiatric disorders and may incur higher costs. In this study, a total of 36,435 GAD patients aged 18 to 64 were identified from a claims database. Patient's total health care and component costs were compared between GAD patients with and without comorbid depression and pain using general linear models. The average total annual cost for all the GAD patients in the study was $7451.

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Comparison of Medication Adherence and Healthcare Costs between Duloxetine and Pregabalin Initiators among Patients with Fibromyalgia

Pain Practice, Aug 27, 2010

Objective: To examine and compare medication adherence and direct healthcare costs between duloxe... more Objective: To examine and compare medication adherence and direct healthcare costs between duloxetine and pregabalin initiators among patients with fibromyalgia. Methods: A retrospective analysis of commercially insured fibromyalgia patients aged 18 to 64 was conducted among those who initiated duloxetine or pregabalin between January 1, 2006 and December 31, 2006. The first initiation date was defined as the index date. All patients included had continuous enrollment in the 12-month pre-and post-index periods. Each individual was classified in the duloxetine or pregabalin cohort based on the initiating agent. The pregabalin cohort was constructed via propensity scoring controlling for differences in demographics, pre-index clinical and economic characteristics, and pre-index treatment patterns. Medication adherence (ie, medication possession ratio [MPR] and proportion of patients with MPR 3 80%) and healthcare costs over the 12 months post-index period were examined between cohorts. Results: The study cohorts included 3,711 duloxetine and 4,111 pregabalin patients with the mean age of 51 years. The common comorbidities included neuropathic pain other than diabetic peripheral neuropathic pain, low back pain, cardiovascular disease, headache, and osteoarthritis. Over 80% of the duloxetine or pregabalin initiators used opioids. Controlling for demographics, pre-index clinical and economic characteristics, and prior medication history, duloxetine patients had significantly higher MPR (0.7 vs. 0.5, P < 0.05), higher proportion of patients with MPR 3 80% (46.5% vs. 26.4%, P < 0.05), but significantly lower total healthcare costs ($19,378 vs. $27,045, P < 0.05) over the 12 months post-index period than pregabalin patients. Conclusion: Fibromyalgia patients on duloxetine had significantly higher medication adherence, but significantly lower direct healthcare costs than those on pregabalin.

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Ensuring Applicability Of Real World Evidence To Individual Patient Decision Making

Value in Health, May 1, 2015

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Daily Dose and Costs Associated With Maintenance Therapy of Topical Testosterone Agents Among Hypogonadal Men

Value in Health, Nov 1, 2014

A519 cally significant (α ≤ 0.05). In contrast, 47 medicines had an average BPS price after CAP s... more

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Duloxetine Use in Employees with Low Back Pain: Treatment Patterns and Direct and Indirect Costs

Pain Medicine, Jun 1, 2014

is the manufacturer of duloxetine. The sponsor reviewed the study design, and reviewed and approv... more is the manufacturer of duloxetine. The sponsor reviewed the study design, and reviewed and approved the final version of the manuscript. Ms. Ivanova and Dr. Birnbaum are employees of Analysis Group, Inc. Mr. Kantor and Mr. Schiller were employees of Analysis Group, Inc., at the time of the study. Dr.

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Comparing clinical and economic characteristics between commercially-insured patients with diabetic neuropathy and demographically-matched diabetic controls

Current Medical Research and Opinion, Jan 16, 2009

To examine medical conditions associated with diabetic neuropathy (DN) and to identify drivers of... more To examine medical conditions associated with diabetic neuropathy (DN) and to identify drivers of healthcare charges and utilization using administrative claims. The study examined commercially-insured under-age-65 individuals with 24 months continuous enrollment in a large US national health plan. DN patients were identified by having at least one claim with a DN diagnosis between July 2004 and June 2005. A demographically-matched control cohort of patients with diabetes but no DN (10: 1 ratio) was constructed using propensity scoring. Overall illness burden via a comprehensive disease classification, year 2 (July 2005 through June 2006) distribution of charges, and reasons for inpatient admissions and emergency room (ER) visits were compared between DN patients and diabetic controls. Multivariate regressions were used to assess the marginal contribution of DN to healthcare charges and utilization, and the most common reasons for ER and inpatient admissions, controlling for differences in overall illness burden. Both DN patients (n = 8655) and diabetic controls (n = 86 550) had a mean age of 51 years, and 46% were female. Compared with controls, DN patients had more comorbid medical conditions (9.7 vs. 6.8, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05) and higher total healthcare charges. Controlling for differences in overall illness burden, DN patients had significantly more hospital days (0.67), more ER (0.09), physician office (0.62), and outpatient hospital visits (2.87), and higher total healthcare charges ($5696) than controls (all p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05), with majority of the difference in charges from inpatient service ($3975, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Patients with DN were also far more likely to be hospitalized (ketoacidosis, neurological manifestation, heart disease, skin infection) or have an ER encounter (amputation) for diabetes-related complications. Due to the use of a retrospective claims database, limitations of this analysis include a lack of formal diagnostic testing of patients, inability to measure factors such as disease duration and severity that are not captured in such databases, and the possible lack of generalization from this group of patients with diabetes to other populations. DN patients had significantly more comorbid medical conditions and higher healthcare charges and utilization than age- and sex-matched diabetic controls. Controlling for differences in overall illness burden, DN patients incurred more ER visits and inpatient admissions.

Energy and improved workplace productivity in depression

Research in human capital and development, May 19, 2004

ABSTRACT

Duloxetine Treatment for Role Functioning Improvement in Generalized Anxiety Disorder

The Journal of Clinical Psychiatry, Apr 15, 2007

Generalized anxiety disorder (GAD) is associated with impaired role functioning and diminished we... more Generalized anxiety disorder (GAD) is associated with impaired role functioning and diminished well-being. The present work examined the efficacy of duloxetine treatment for improving functional outcomes for patients with GAD in 3 independent clinical studies. Studies were randomized, double-blind, placebo-controlled multicenter trials conducted in adult outpatients with DSM-IV-defined GAD. One study compared 9-week fixed-dose treatment with duloxetine 60 or 120 mg (N = 168 and N = 170, respectively) with placebo (N = 175). The other 2 studies compared 10-week flexible-dose treatment with duloxetine 60-120 mg (study 2, N = 168; study 3, N = 162) with placebo (study 2, N = 159; study 3, N = 161). The main functional outcome measure for each study was the Sheehan Disability Scale (SDS). Additional measures were the Quality of Life Enjoyment and Satisfaction Questionnaire Short Form and the European Quality of Life 5 Dimensions. The 3 studies were conducted in the time period from June 2004 to November 2005. Duloxetine-treated patients improved significantly more than placebo-treated patients on SDS global functioning (study 1, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;or= .001; studies 2 and 3, p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;or= .01) and SDS work, social life, and family/home responsibility scores (p values range from &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;or= .05 to &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;or= .001). At treatment endpoint, a greater percentage of duloxetine-treated patients had obtained SDS global functioning scores in the normative range than placebo-treated patients (p values range from &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;or= .05 to…

Comparative and Interactive Effects of Depression Relative to Other Health Problems on Work Performance in the Workforce of a Large Employer

Journal of Occupational and Environmental Medicine, Jul 1, 2008

used to assess self-reported health problems and work performance. Survey data were linked to med... more used to assess self-reported health problems and work performance. Survey data were linked to medical-pharmacy claims data. Regression analysis was used to assess comparative effects of depression in the absence and presence of comorbidities on Health and Work Performance Questionnaire measures of work performance. Results: Depression had the largest individuallevel effect on work performance of any condition examined. Several comorbid conditions exacerbated the effect of depression, but had no effects in the absence of depression. Conclusions: Depression is a strong predictor of decrements in work performance. Other conditions that often co-occur with depression, including anxiety and fatigue-sleep disturbance, exacerbate the adverse effect of depression.

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Efficacy of Duloxetine and Selective Serotonin Reuptake Inhibitors

Journal of Clinical Psychopharmacology, Dec 1, 2007

It has been proposed that serotonin and norepinephrine reuptake inhibitors (SNRIs) may result in ... more It has been proposed that serotonin and norepinephrine reuptake inhibitors (SNRIs) may result in higher remission rates of major depressive disorder than therapy with selective serotonin reuptake inhibitors (SSRIs). To test this hypothesis, a meta-analysis of individual patient data (N = 1833) was performed for the complete set of 6 phase II/III studies that compared duloxetine (fixed doses; range, 40-120 mg/d) with 2 SSRIs (paroxetine or fluoxetine; 20 mg/d) in outpatients with major depressive disorder. Remission was defined as an end point score of less than or equal to 7 on the 17-item Hamilton Rating Scale for Depression (HAMD 17); alternate outcome criteria were also examined, as were remission rates among the 1044 patients with moderate-to-severe depression (HAMD 17 total score greater than or equal to 19). The HAMD 17 remission rates were 40.3% (351/871), 38.3% (162/423), and 28.4% (144/507) for duloxetine, the 2 SSRIs, and placebo, respectively. Both active treatments were superior to placebo; the difference between duloxetine and SSRIs was not statistically significant. Similar findings were observed for alternate outcomes. Duloxetine therapy was significantly more effective than therapy with the 2 SSRIs for patients with more severe depression, with remission rates of 35.9% (183/510) versus 28.6% (70/245) (P = 0.046). A secondary analysis of dose-response relationships indicated that this advantage was not attributable to the studies using higher doses of duloxetine. Thus, whereas duloxetine and the 2 SSRIs were comparably efficacious overall, therapy with the serotonin and norepinephrine reuptake inhibitor resulted in a significantly higher remission rate among patients with moderate-to-severe depression.

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A Symptom Checklist to Screen for Somatoform Disorders in Primary Care

Psychosomatics, May 1, 1998

Current DSM-IV somatoform diagnoses may inadequately capture many somatizing patients in primary ... more Current DSM-IV somatoform diagnoses may inadequately capture many somatizing patients in primary care. By using data from two studies (1,000 and 258 patients, respectively), the authors determined 1) the optimal threshold on a checklist of 15 physical symptoms to screen for a recently proposed somatoform diagnosis, multisomatoform disorder (MSD), and 2) the concordance between MSD and somatization disorder. The optimal threshold for pursuing a diagnosis of MSD was seven or more physical symptoms. The majority (88%) of the patients who met criteria for MSD had either full or abridged somatization disorder. MSD was intermediate between abridged and full somatization disorder in terms of its association with functional impairment, psychiatric comorbidity, family dysfunction, and health care utilization and charges.

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Units and costs per day per claim of comparable insulins supplied to medicaid patients

Value in Health, May 1, 2014

A261 diabetes patients increased substantially in the past two decades. Future studies may consid... more

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PDB35 Clinical and Economic Characteristics of Patients with Diabetic Neuropathy

Value in Health, May 1, 2008

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PMH75 Predictors and Costs of MDD Treatment with Duloxetine Compared with Venlafaxine Extended Release

Value in Health, Oct 1, 2009

The reassessment of CEA after price cut of comparators (up to-10%, due to international price ref... more The reassessment of CEA after price cut of comparators (up to-10%, due to international price referencing) has showed the positive results for agomelatine and robustness of previous price sensitivity analysis. CONCLUSIONS: The focus of the MoH drug policy is on more rational spendings , especially on reference pricing and HTA. There are first results of these new procedures, where the real impact of the HTA in the decision processes is demonstrated. Agomelatin, a new agent in therapy of depression fulfilled, the necessary legislative conditions including pharmacoeconomic aspects to be listed in the positive reimbursement list.

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PMH34 Determinants in Antidepressant Treatment Selection Following the Introduction of Duloxetine

Value in Health, May 1, 2006

location, salary, race, marital status, full-time/part-time status, prior comorbidity index, prio... more location, salary, race, marital status, full-time/part-time status, prior comorbidity index, prior medical costs related to BPD, prior other medical costs, index date, and medical services related to BPD). Treatment groups were compared over a followup period ranging from 12 to 24 months after the index prescription date. RESULTS: Six hundred ninety-nine patients with BPD were classified into the ATYP (n = 25), BOTH (n = 190), NONE (n = 170), and OTHER (n = 314) treatment groups. The ATYP group demonstrated the lowest rate of employment termination (1.5%; 95% CI-3.3%, 6.3%) followed by the BOTH (5.8%; 95% CI 2.5%, 9.1%), NONE (8.9; 95% CI 4.7%, 13.2%), and OTHER (9.3%; 95% CI 6.1%, 12.5%) groups. Differences between treatment groups were not significant. The numerical difference between ATYP and OTHER did not reach significance (p = 0.058). CONCLUSIONS: The ATYP group demonstrated the lowest employment termination rate in the follow-up period of 12 to 24 months after the index prescription date. Further research is warranted to examine the influence of specific patient variables and treatment regimens on employment termination in patients with BPD.

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Can mental health treatment be effectively delivered in primary care? A primer for employee benefit design, decision makers, and an outcome research example

Research in human capital and development, May 19, 2004

ABSTRACT

The “monitoring model” and the Mortality × Treatment interaction threat to validity in mental health outcome evaluation

American Journal of Community Psychology, Oct 1, 1982

... A z test of equality of these propor-tions yielded az of 1.81, p = .07. These rates are repre... more

Treatment patterns associated with Duloxetine and Venlafaxine use for Major Depressive Disorder

BMC Psychiatry, Jan 31, 2011

Background: Duloxetine and venlafaxine extended release (venlafaxine XR) are SNRIs indicated for ... more Background: Duloxetine and venlafaxine extended release (venlafaxine XR) are SNRIs indicated for the treatment of MDD. This study addresses whether duloxetine and venlafaxine XR are interchangeable in their patterns of use with patients who are depressed or are used more selectively based on treatment history, background characteristics, and presenting symptoms. Methods: This was a retrospective analysis of an administrative insurance claims database. We studied patients in managed care with major depressive disorder (MDD) treated with duloxetine or venlafaxine XR. Predictors of treatment and cost were assessed using Chi-square and logistic regression analyses of demographics and past-year medication use and comorbidities. Results: Patients with MDD treated with duloxetine (n = 9,641) versus venlafaxine XR (n = 8,514) tended to be older, slightly more likely to be female, and treated by a psychiatrist (P < 0.0001). In the prior year, more duloxetine patients (vs. venlafaxine XR) received ≥3 unique antidepressants (20.8% vs. 16.6%), ≥3 unique pain medications (25.5% vs. 15.6%), and had ≥8 unique diagnosed comorbid medical and psychiatric conditions (38.6% vs. 29.1%). The prior 6-month total health care costs were $1,731 higher for duloxetine than for venlafaxine XR and declined for both medications in the 6 months after treatment began. Logistic regression analysis revealed that 61% of duloxetine patients and 61% of venlafaxine XR patients were predictable from prior patient and treatment factors. Conclusions: Patients with MDD treated with duloxetine tended to have a more complex and costly antecedent clinical presentation compared with venlafaxine XR patients, suggesting that physicians do not use the medications interchangeably.

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Prevalence of other diabetes-associated complications and comorbidities and its impact on health care charges among patients with diabetic neuropathy

Journal of Diabetes and Its Complications, 2010

Introduction: Diabetic neuropathy (DN) is a common complication associated with diabetes. This st... more Introduction: Diabetic neuropathy (DN) is a common complication associated with diabetes. This study assesses the prevalence of other diabetes-related complications or comorbidities among DN patients and its marginal contribution to health care charges. Methods: Using administrative claims database, we studied commercially insured patients below 65 years old with at least one claim of DN anytime from July 2004 through June 2005 (Year 1). Using propensity scoring, a 10:1 ratio of demographically matched controls with diabetes but no DN was constructed. Both DN patients and controls had 12 months of continuous enrollment in Year 1 and Year 2 (July 2005-June 2006). We compared the Year 1 prevalence of other diabetes-associated complications or comorbidities between DN patients and diabetic controls. Controlling for comorbidities, we used multivariate regressions to examine the incremental impact of DN or any other diabetes-related complication or comorbidity on Year 2 health care charges. Results: A higher percentage of DN patients had at least one other diabetesrelated complication or comorbidity than diabetic controls. Individuals with DN had a higher prevalence of each individual other diabetesrelated complication or comorbidity. Controlling for comorbidities, the presence of any other diabetes-related complication or comorbidity was statistically associated with higher outpatient pharmacy and total charges for both DN patients and controls. Total and outpatient pharmacy charges were also significantly higher for DN patients than for controls, among those with or without any other diabetes-related complications or comorbidities. Conclusions: DN can occur in the absence of other diabetes-related complications or comorbidities. The presence of DN and any other diabetes-related complications or comorbidities significantly increases health care charges.

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Value in Health, May 1, 2003

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The Cost of Comorbid Depression and Pain for Individuals Diagnosed With Generalized Anxiety Disorder

Journal of Nervous and Mental Disease, Feb 1, 2009

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Comparison of Medication Adherence and Healthcare Costs between Duloxetine and Pregabalin Initiators among Patients with Fibromyalgia

Pain Practice, Aug 27, 2010

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Ensuring Applicability Of Real World Evidence To Individual Patient Decision Making

Value in Health, May 1, 2015

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