Economic impact of using cariprazine as the first versus subsequent adjunctive therapy for Medicaid beneficiaries with major depressive disorder.

BACKGROUND

Timely initiation of appropriate major depressive disorder (MDD) therapy is crucial. Medicaid-insured patients with MDD have higher healthcare resource utilization (HRU) and costs than commercially insured patients, making this group essential to study.

METHODS

Claims in the MerativeTM MarketScan® Medicaid Database (2016 to 2022) were used to determine all‑cause and mental health (MH)‑related HRU and healthcare costs of US adults with MDD and ≥ 1 pharmacy claim for cariprazine adjunctive to antidepressant treatment. Outcomes were evaluated in patients initiating cariprazine as their first adjunctive therapy and those initiating cariprazine as a subsequent adjunctive therapy (e.g. after another atypical antipsychotic [AA], non-AA, antidepressant treatment combination). HRU and costs were compared with rate ratios (RRs) and mean cost differences between weighted cariprazine adjunctive therapy cohorts.

RESULTS

Among 970 Medicaid beneficiaries meeting inclusion criteria, 392 initiated cariprazine as their first adjunctive therapy and 578 initiated it as a subsequent adjunctive therapy. Patients initiating cariprazine first had significantly lower rates of all‑cause emergency department visits (RR [95% CI] = 0.78 [0.66, 0.94], p < .001) and outpatient (OP) visits (0.80 [0.67, 0.92], p = .012) per patient‑year than those initiating cariprazine subsequently. This translated to lower annual all‑cause medical costs (-$2,101 [-$5,096, -$7], p = .048), driven by lower OP costs (-$2,385, [-$5,251, -$492], p = .016) per patient per year. MH‑related HRU and costs were also significantly lower.

CONCLUSIONS

Findings from this real‑world study of Medicaid beneficiaries indicate that earlier cariprazine use is associated with potential reduction in the substantial humanistic and economic burden of MDD.