Clinical and economic impact of non-adherence to antidepressants in major depressive disorder

a systematic review

Siew Ching Ho, Huey Yi Chong, Nathorn Chaiyakunapruk, Balamurugan Tangiisuran, Sabrina Anne Jacob

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

BACKGROUND: Medication non-adherence is one of the major challenges in treating patients with depression. This systematic review aims to determine the clinical and economic outcomes of non-adherence in depression.

METHODS: A systematic search was performed across the following databases: PubMed, EMBASE, DARE, CINAHL, PsycINFO, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews; from database inception to March 31, 2015. Studies must report on the association between adherence and outcomes, and English full texts needed to be available. The quality of each study was assessed using the Newcastle-Ottawa scale.

RESULTS: A total of 11 articles were included, with eight reporting on clinical outcomes, two reporting on economic outcomes, and one reporting on both. The majority of studies were retrospective cohort studies. The mean quality of all included studies was 7, with a range from 3 to 9. Results clearly indicate that patients who were non-adherent were more likely to experience increased risks of relapse and/or recurrence, emergency department visits, and hospitalization rates; increased severity of depression, and a decrease in response and remission rates. The worsening of clinical outcomes in patients who were non-adherent subsequently translated to an increase in healthcare utilization and charges.

LIMITATIONS: No standardized adherence measurement tools were used, and few studies looked at the economic impact of non-adherence in depression.

CONCLUSION: There is a strong association between non-adherence to antidepressants and a worsening of patients' clinical and economic outcomes. Cost-effective interventions should be directed to this group of patients to improve medication adherence.

Original languageEnglish
Pages (from-to)1-10
Number of pages10
JournalJournal of Affective Disorders
Volume193
DOIs
Publication statusPublished - 15 Mar 2016

Fingerprint

Major Depressive Disorder
Antidepressive Agents
Economics
Depression
Medication Adherence
Databases
Recurrence
PubMed
Hospital Emergency Service
Hospitalization
Cohort Studies
Retrospective Studies
Delivery of Health Care
Costs and Cost Analysis

Keywords

  • antidepressive agents
  • depressive disorder
  • medication adherence

Cite this

Ho, Siew Ching ; Chong, Huey Yi ; Chaiyakunapruk, Nathorn ; Tangiisuran, Balamurugan ; Jacob, Sabrina Anne. / Clinical and economic impact of non-adherence to antidepressants in major depressive disorder : a systematic review. In: Journal of Affective Disorders. 2016 ; Vol. 193. pp. 1-10.
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Clinical and economic impact of non-adherence to antidepressants in major depressive disorder : a systematic review. / Ho, Siew Ching; Chong, Huey Yi; Chaiyakunapruk, Nathorn; Tangiisuran, Balamurugan; Jacob, Sabrina Anne.

In: Journal of Affective Disorders, Vol. 193, 15.03.2016, p. 1-10.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Clinical and economic impact of non-adherence to antidepressants in major depressive disorder

T2 - a systematic review

AU - Ho, Siew Ching

AU - Chong, Huey Yi

AU - Chaiyakunapruk, Nathorn

AU - Tangiisuran, Balamurugan

AU - Jacob, Sabrina Anne

N1 - Copyright © 2015 Elsevier B.V. All rights reserved.

PY - 2016/3/15

Y1 - 2016/3/15

N2 - BACKGROUND: Medication non-adherence is one of the major challenges in treating patients with depression. This systematic review aims to determine the clinical and economic outcomes of non-adherence in depression.METHODS: A systematic search was performed across the following databases: PubMed, EMBASE, DARE, CINAHL, PsycINFO, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews; from database inception to March 31, 2015. Studies must report on the association between adherence and outcomes, and English full texts needed to be available. The quality of each study was assessed using the Newcastle-Ottawa scale.RESULTS: A total of 11 articles were included, with eight reporting on clinical outcomes, two reporting on economic outcomes, and one reporting on both. The majority of studies were retrospective cohort studies. The mean quality of all included studies was 7, with a range from 3 to 9. Results clearly indicate that patients who were non-adherent were more likely to experience increased risks of relapse and/or recurrence, emergency department visits, and hospitalization rates; increased severity of depression, and a decrease in response and remission rates. The worsening of clinical outcomes in patients who were non-adherent subsequently translated to an increase in healthcare utilization and charges.LIMITATIONS: No standardized adherence measurement tools were used, and few studies looked at the economic impact of non-adherence in depression.CONCLUSION: There is a strong association between non-adherence to antidepressants and a worsening of patients' clinical and economic outcomes. Cost-effective interventions should be directed to this group of patients to improve medication adherence.

AB - BACKGROUND: Medication non-adherence is one of the major challenges in treating patients with depression. This systematic review aims to determine the clinical and economic outcomes of non-adherence in depression.METHODS: A systematic search was performed across the following databases: PubMed, EMBASE, DARE, CINAHL, PsycINFO, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews; from database inception to March 31, 2015. Studies must report on the association between adherence and outcomes, and English full texts needed to be available. The quality of each study was assessed using the Newcastle-Ottawa scale.RESULTS: A total of 11 articles were included, with eight reporting on clinical outcomes, two reporting on economic outcomes, and one reporting on both. The majority of studies were retrospective cohort studies. The mean quality of all included studies was 7, with a range from 3 to 9. Results clearly indicate that patients who were non-adherent were more likely to experience increased risks of relapse and/or recurrence, emergency department visits, and hospitalization rates; increased severity of depression, and a decrease in response and remission rates. The worsening of clinical outcomes in patients who were non-adherent subsequently translated to an increase in healthcare utilization and charges.LIMITATIONS: No standardized adherence measurement tools were used, and few studies looked at the economic impact of non-adherence in depression.CONCLUSION: There is a strong association between non-adherence to antidepressants and a worsening of patients' clinical and economic outcomes. Cost-effective interventions should be directed to this group of patients to improve medication adherence.

KW - antidepressive agents

KW - depressive disorder

KW - medication adherence

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M3 - Article

VL - 193

SP - 1

EP - 10

JO - Journal of Affective Disorders

JF - Journal of Affective Disorders

SN - 0165-0327

ER -