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Background The extent to which patient-based outcomes can be used to evaluate and communicate the effect of new drugs and devices is a subject of much debate. Criteria for evaluating the scientific quality of data to support health-related quality of life (HRQL) and other patient-based labeling and promotional claims in the United States and Europe have been proposed by various scientists and organizations. Since March 2000, a working group composed of members of the International Society for Quality of Life Research (ISOQOL), the International Society for Pharmacoeconomics and Outcomes Research (ISPOR), the Pharmaceutical Manufacturer's Association Health Outcomes Committee (PhRMA-HOC), and the European Regulatory Issues on Quality of Life Assessment (ERIQA) met to discuss and coordinate the various recommendations by their respective groups and address the need to harmonize outcomes review criteria within and across United States and European regulatory agencies. Over time, the discussion expanded from HRQL outcomes to include any outcome based on data provided by the patient or patient proxy, that is, patient-reported outcomes (PROs). The working group therefore became known as the PRO Harmonization Group. Methods Working with a member of the US Food and Drug Administration (FDA), four key issues requiring clarification were identified: how PROs are defined and put into operation for research purposes; the added value of PROs in the drug review and evaluation process; selected questions related to the PRO measurement and research methodology; and the interest and demand for PRO information by decision makers. On February 15, 2001, all members of the PRO Harmonization Group attended a meeting in Rockville, Maryland, to discuss these four issues further, and on February 16, 2001, a formal presentation was made to representatives from various departments and reviewing divisions of the FDA. These presentations are summarized in this report. Results All participants agreed that PROs are important for understanding the impact of treatment on patient functioning and well-being. They also stressed the need to communicate PRO information to key decision makers, including regulatory agencies, clinicians, patients and their families, and payers. Finally, the meeting resulted in plans for continuing the dialogue on PRO measurement and interpretation. Summary The February 16, 2001, meeting represented an important step in harmonizing efforts across various organizations and in opening a dialogue with the FDA around major issues related to methodologic standards for measuring and interpreting PROs in the drug evaluation process.

OBJECTIVES: To assess differences in the health care resource use of patients who received selective serotonin reuptake inhibitor (SSRI) antidepressants. METHODS: Retrospective analysis of administrative medical claims from 1/97–12/99 was conducted using Protocare Sciences' Managed Care Database. Patients were categorized as early discontinued or continued ( one agent). Total health care costs were compared across these categories. RESULTS: Under half (48%) of the 11,119 SSRI users studied continued antidepressant therapy for at least 6 months. Two-thirds of all patients received monotherapy; 19% switched agents (44% of switches were in the first three months of therapy); 15% used multiple agents. Eight percent of patients who discontinued early had switched agents within the specified 6 month period; 90% of these switches occurred in the first three months. For patients who continued therapy for 6 months, the average total health care charges per patient per month (PPPM) during the first three therapy months were $906 (switch by third month), $568 (switch by sixth month), $496 (switch by twelfth month) and $375 (switch after twelfth month). PPPM charges in the first six therapy months ranged from $452–$921 for discontinued patients and from $423–$483 for non-switched, continued patients. CONCLUSIONS: Patients who discontinued SSRI therapy early tended to have higher costs than patients who continued therapy. It is unclear whether these increased costs stem from treatment of medication side effects or increased utilization related to lack of efficacy of the initial antidepressant. Alternatively, early switchers may simply be more clinically complex patients.