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We compared healthcare expenditure over a six‐month period following initiation of therapy with either venlafaxine (immediate and extended‐release) or a selective serotonin reuptake inhibitor (SSRI) in depressed patients with or without anxiety. Patients beginning treatment for a new depressive episode were identified retrospectively using the administrative data of the MEDSTAT MarketScan® database for the period 1994–1999. Before beginning therapy, patients prescribed venlafaxine had more non‐mental illnesses (0.85 vs0.76; p<0.01) and hospitalisations for mental illness (0.53 vs0.29; p<0.05) than patients prescribed SSRIs. In the six months after initiating treatment, venlafaxine was associated with lower hospitalisation expenditure for non‐mental illness ($177 vs$526; p<0.01) than SSRIs, although total healthcare expenditure was not significantly different. Venlafaxine was associated with a 50% decrease in the odds of hospitalisation for non‐mental illness compared with SSRIs, with significantly lower inpatient expenditure.

Previous studies of antidepressants in clinical practice have established a link between initial antidepressant selection and patterns of antidepressant use and health care expenditures. However, there has been far less research to date demonstrating a link between the patterns of antidepressant use and patients' clinical outcomes using data from actual clinical practice.OBJECTIVE: The purpose of this study using data from a clinical practice setting was to test whether the pattern of antidepressant use was correlated with patients' treatment response as measured by the score on the Clinical Global Impressions-Improvement scale. DATA AND METHODS: A dataset of patients who initiated therapy on one the most common selective serotonin reuptake inhibitors (SSRLs) fluoxetine, fluvoxamine, paroxetine, or sertaline in a general practitioner setting in Spain was used. A Cox proportional hazard analysis was used to predict the liklihood of treatment response based upon the pattern of initial antidepressant use, while controlling for the influence of other baseline characteristics. RESULTS: After controlling for other observed baseline characteristics including initial disease severity, patients who remained on their initial antidepressant therapy for at least two months with no switching, augmentation, or upward dose titration were 63.2% more likely (p < 0.05) than patients who had an adjustment to therapy to exprience a treatment response. CONCLUSION: The pattern of antidepressant use is an important determinant of treatment response among patients initiating therapy on the newer antidepressants in clinical practice.

The constraints on healthcare delivery have created demand for intervention analyses that address the “real world,” naturalistic setting. Retrospective databases can provide a narualistic view of drug and service utilization derived from administrative data. However, there are times when administrative data does not fully address decision-makers' questions. When this is the case, prospective non-randomized studies represent another approach that can collect more comprehensive data. This workshop will explore the development and implementation of such a study, the Schizophrenia Care and Assessment Program (SCAP). SCAP evaluates the relationship between usual medical care as delivered in various health systems and clinical, humanistic, and economic outcomes or patients with schizophrenia. SCAP is currently enrolling in the United States and Australia where each patient will be followed for three years. The total sample will be 2,700 participants. The workshop will cover three development stages of this project: (1) retrospective view of drug and service utilizations patterns, (2) protocol development, (3) site start-up and baseline characteristics of the enrollees. The use pattern portion of the workshop will discuss methods appropriate for analyses in retrospective database studies. The protocol development section will discuss instrument development, insturment selection, and administration for the setting of a naturalistic study. The site start-up and baseline characteristics section will discuss training and enrollment issues in a study of this size and the practical issues surrounding MIS resource use data. Early baseline characteristics on an expected sample of 250 U.S. enrollees will also be discussed. Attendees will gain an understanding of design and implementation issues in naturalistic settings for marketed products. Professionals who expect to be involved in prospective outcomes studies or who are interested in exploring this option should attend.