TitleImpact of sertraline daily treatment regimen on adherence, persistence, and healthcare resource utilization in patients with major depressive disorder or obsessive-compulsive disorder: A real-world evidence analysis from the United States
OBJECTIVE To generate real-world evidence (RWE) from the United States to assess the impact of pill burden and the importance of achieving stable daily dose of sertraline (time taken, number of dose adjustments needed) on adherence/persistence and healthcare resource utilization (HCRU).
METHODS Retrospective analysis of the PharMetrics® Plus database (Oct/1/2012-Mar/31/2020) in the United States. Eligible patients had major depressive disorder (MDD) or obsessive-compulsive disorder (OCD) and ≥1 claim for sertraline during index period (Apr/1/2013-Mar/31/2019, allowing 6-months prior, 1-year post-index follow-up). Patients who achieved stable daily dose of sertraline (>90-days on same dose) were categorized into five cohorts, depending on pill burden/daily dose: Cohort 1: 1×50mg/day; Cohort 2: 1×100mg/day; Cohort 3: 2×50mg/day; Cohort 4: 1.5×100mg/day; Cohort 5: 3×50mg/day. Impact of pill burden on adherence/persistence and HCRU were assessed among cohorts using logistic regression analysis, and between patients who did vs. did not stabilize on therapy. P<0.05 was considered significant for all analyses.
RESULTS Of 224,412 eligible patients, 108,729 stabilized on sertraline (50, 100, 150mg/day) and formed Cohorts 1-5. Stabilized patients on lower pill burden had statistically higher adherence and were more likely to remain persistent throughout 1-year post-index period vs. patients on higher pill burden but same overall dose (100mg/day [Cohort 2 vs. 3]; 150mg/day [Cohort 4 vs. 5]; respectively). Patients who did not stabilize had significantly lower adherence/persistence vs. patients who achieved stable daily dose (Cohorts 1-5 combined). Persistence improved when stable daily dose was achieved quickly (within 1-4 months) and efficiently (within 1-3 dose adjustments). Probability of HCRU increased for patients who did not stabilize on their initial prescription.
CONCLUSION Simplifying treatment regimen and decreasing pill burden improved adherence and/or persistence with sertraline therapy (100 or 150mg/day). Patients achieving stable daily dose of sertraline in an efficient and timely manner were more likely to remain persistent throughout 1-year follow-up.