The newer antidepressant drugs, selective serotonin reuptake inhibitors (SSRIs), are used more often than older tricyclic antidepressants (TCAs), atypical antidepressants, and other medications to treat patients hospitalized for depression. SSRIs also have the highest medication charges, according to a study supported by the Agency for Healthcare Research and Quality (HS09551).
TCAs have greater potential toxicity than SSRIs and require far more medical tests and monitoring. Atypical antidepressants are usually reserved for patients who have not responded to conventional antidepressants. They are often treated with electroconvulsive therapy (ECT) and have longer hospital stays, which contribute to their higher overall charges.
Researchers led by Deborah L. Ackerman, M.S., Ph.D., of the University of California, Los Angeles (UCLA) School of Public Health, reviewed billing data of the UCLA Neuropsychiatric Hospital from 1994 to 1997 for all 1,698 hospitalizations for mood disorders (manic depression, major depression, and depressive disorder). Overall, only 0.5 percent of total inpatient charges for these patients were for antidepressants. SSRIs such as fluoxetine and paroxetine were the most commonly prescribed medications (47 percent) followed by the atypicals such as trazodone and bupropion (12 percent), the tricyclics such as amitriptyline and doxepine (7 percent), venlafaxine (7 percent), and the monoamine oxidase inhibitors (MAOIs, less than 1 percent).
After controlling for hospital length of stay, patient age and sex, and coexisting illnesses, the atypicals were associated with the highest total inpatient charges: $2,000 more than MAOIs, $600 more than SSRIs, and $600 more than venlafaxine. Patients who received multiple drugs or atypicals had the highest inpatient charges (mean of $21,204 and $20,344, respectively) and longest stays (16 and 15 days, respectively, vs. 10 days for SSRIs). When charges for rooms were subtracted from total charges, length of stay accounted for 43 percent and drug class accounted for 4 percent of the variation in total charges.
More details are in "Inpatient treatment of depression and associated hospital charges," by Dr. Ackerman, Jurgen Unutzer, M.D., M.P.H., Sander Greenland, M.S., Dr.P.H., and Michael Gitlin, M.D., in the April/May 2002 Pharmacoepidemiology and Drug Safety 11(3), pp. 219-227.