Workplace productivity, employment issues, and resource utilization in patients with bipolar I disorder.

OBJECTIVE: To collect workplace productivity and healthcare utilization data from subjects with bipolar I disorder and compare the results with those from normative subjects. METHODS: A cross sectional survey was administered to patients and recruiting physicians. Data collected included employment status, Endicott Workplace Productivity Scale (EWPS) results, healthcare resource utilization, and quality-of-life. RESULTS: In comparison with normative subjects, bipolar I subjects reported lower levels of work productivity (measured by the EWPS). Bipolar I subjects also reported more frequent outpatient visits and more prescribed pharmaceuticals. Bipolar I subjects were more likely to miss work, have worked reduced hours due to medical or mental health issues, receive disability payments, been involved in a crime, be uninsured or covered by Medicare, or have been fired or laid off. The study groups were age- and gender-matched to reduce the impact of selection bias associated with a non-randomized study design. Other potential limitations affecting the results of the study include recall bias and possibly an impact of different data collection methods (e.g. Internet versus telephone). CONCLUSIONS: Bipolar I disorder is associated with a negative effect on work productivity and resource utilization and is an appropriate disease management target for employers and healthcare decision makers.

Cost and effectiveness of venlafaxine extended-release and selective serotonin reuptake inhibitors in the acute phase of outpatient treatment for major depressive disorder.

OBJECTIVE: The purpose of this retrospective analysis was to estimate the cost and effectiveness of venlafaxine extended-release (VXR) compared with selective serotonin reuptake inhibitors in the outpatient treatment of major depressive disorder. METHODS: Pooled data from 8, 8-week, randomized, double-blind studies comparing treatment of major depressive disorder with venlafaxine/venlafaxine XR (n = 851), selective serotonin reuptake inhibitors (fluoxetine, paroxetine, fluvoxamine; n = 748), or placebo (4 studies; n = 446) were retrospectively analyzed to determine the economic implications of symptom remission from the perspective of a US third party payer and that of an employer. A decision modeling approach was used to determine cost and effectiveness ratios. RESULTS: Patients on VXR were associated with 22.8 depression-free days versus 18.6 depression-free days with the studied selective serotonin reuptake inhibitors, based on the decision model. Productive and quality-adjusted days were also expected to increase for VXR patients (22.06 vs. 19.34 and 4.56 to 9.36 vs. 3.72 to 7.63), as was the percentage of patients achieving full activity (25.9% vs. 19.6%). The expected cost per patient achieving remission of symptoms was US 1303.94 dollars and US 1514.96 dollars, and the cost per depression-free days was US 25.66 dollars and US 28.25 dollars, for the VXR and selective serotonin reuptake inhibitors groups, respectively. CONCLUSIONS: Treatment with VXR is not only expected to increase the rate of remission of symptoms but is also associated with achievement of full activity, higher number of depression-free days, productive days, and quality-adjusted days. VXR is a cost-effective treatment option for major depressive disorder.

Retrospective cohort study of venlafaxine, fluoxetine or sertraline in long-term care.

OBJECTIVE: To describe the effects of venlafaxine, fluoxetine and sertraline treatment on mood and behaviour patterns, physical functioning, and tolerability issues in a long-term care environment. DESIGN, SETTING AND PARTICIPANTS: Retrospective cohort analysis of 257 elderly residents of three long-term care facilities in the US who used venlafaxine, fluoxetine or sertraline during a 3-month period. MAIN OUTCOME MEASURES: Indicators of depression, anxiety and sad mood, physical functioning, antidepressant-related adverse events, and the global impression of efficacy. RESULTS: The average age of the participants was 80.6 years. At the 3-month follow-up, more than 85% of the residents recorded no change in indicators of depression, anxiety and sad mood or physical functioning, and there were no statistically significant differences among the three antidepressant drug groups. A marginal improvement in the social interaction indicator was observed among residents who received venlafaxine (11%) compared with those receiving fluox-etine (3%) or sertraline (2%). Antidepressant-related adverse events were infrequent and similar in incidence across the three drug groups. CONCLUSIONS: Indicators of mood and functioning of most residents were stable over the 3-month period and similar among the venlafaxine, fluoxetine and sertraline groups, and no significant differences in the safety profiles of the three drugs were recorded.