COMPARISON OF HEALTHCARE USE AND COSTS OF ADULT PATIENTS WITH “PURE OBSESSIVE-COMPULSIVE DISORDER” VERSUS “PURE DEPRESSION”: NINE-YEAR CLAIMS ANALYSIS OF FLORIDA MEDICAID ENROLLEES C. Hankin 1 ; L.M. Koran 2 ; L. Culpepper 3 ; J. Knispel 4 ; D. Dougherty 5 ; E. Hollander 6 ; D.V. Sheehan 7 ; J. Dunn 8 ; A. Levin 9 ; D.W. Black 10 ; A. Bronstone 1 ; S. Wang 1 1 BioMedEcon, LLC, Moss Beach, CA; 2 Stanford University, Stanford, CA; 3 Boston University, Boston, MA; 4 Humana, Singer Island, FL; 5 Massachusetts General Hospital, Boston, MA; 6 Mount Sinai School of Medicine, New York, NY; 7 University of South Florida, Tampa, FL; 8 SelectHealth, Inc., Salt Lake City, UT; 9 Health Plus, Bronx, NY; 10 University of Iowa, Iowa City, IA Research Funded by Jazz Pharmaceuticals, Inc. 1 Society of General Internal Medicine, 31 st Annual Meeting; April 11, 2008; Pittsburgh, PA
BACKGROUND: OBSESSIVE-COMPULSIVE DISORDER (OCD) • Anxiety disorder characterized by • Recurrent, unwanted thoughts (obsessions) and/or • Repetitive behaviors (compulsions) • U.S. estimated prevalence 2% • Many studies document higher use of outpatient medical services among depressed patients • Anecdotal reports among patients with OCD • Healthcare (medical and psychiatric) costs? 2 Society of General Internal Medicine, 31 st Annual Meeting; April 11, 2008; Pittsburgh, PA
OBJECTIVE • Compare healthcare use and costs of newly- diagnosed 1 patients with “pure OCD” 2 (P-OCD) to matched 3 sample of newly-diagnosed patients with “pure depression”(P-D) 4 1. Newly-diagnosed: No OCD (or depression) diagnosis 2 years preceding 1st (index) diagnosis 2. Pure OCD: no pre-existing or comorbid bipolar disorder, psychoses, or depression 3. Matched: sex, race/ethnicity, medical illness severity (Charlson index), age/year at index diagnosis 4. Pure Depression: no pre-existing or comorbid bipolar disorder, psychoses, or OCD) 3 Society of General Internal Medicine, 31 st Annual Meeting; April 11, 2008; Pittsburgh, PA
METHODS: FLORIDA MEDICAID DATASET • Florida Medicaid: > 5 million enrollees • Computerized claims records • Demographics • ICD-9 (diagnoses) • CPT (procedures) • NDC (drugs) • Information patient de-identified and HIPAA compliant • BioMedEcon obtained 9 years of data (1997-2006) 4 Society of General Internal Medicine, 31 st Annual Meeting; April 11, 2008; Pittsburgh, PA
RESULTS: MEDIAN OVERALL 2-YEAR HEALTHCARE COSTS Overall Healthcare Costs Were Significantly Higher in Patients with P-OCD versus P-D $30,000 p<0.0001 p<0.0001 P-OCD Median Healthcare Costs ($) P-D $25,666 $15,000 $24,799 p<0.0001 $7,056 $7,832 $943 $3,390 $0 Overall Healthcare Overall Medical Overall Psychiatric Costs Costs Costs 5 Society of General Internal Medicine, 31 st Annual Meeting; April 11, 2008; Pittsburgh, PA
RESULTS: MEDIAN OVERALL 2-YEAR HEALTHCARE COSTS Overall Healthcare Costs Were Significantly Higher in Patients with P-OCD versus P-D $30,000 p<0.0001 p<0.0001 P-OCD Median Healthcare Costs ($) P-D Medical and Psychiatric) Costs $25,666 were Significantly Higher in $15,000 $24,799 Patients with P-OCD vs P-D p<0.0001 $7,056 $7,832 $943 $3,390 $0 Overall Healthcare Overall Medical Overall Psychiatric Costs Costs Costs 6 Society of General Internal Medicine, 31 st Annual Meeting; April 11, 2008; Pittsburgh, PA
Summary of Results Total Medical Psychiatric Costs Costs Costs Overall Healthcare Costs Inpatient Costs NS NS - Outpatient Costs NS Pharmacy Costs NS 7 Society of General Internal Medicine, 31 st Annual Meeting; April 11, 2008; Pittsburgh, PA
MEDIAN 2-YEAR INPATIENT COSTS Total Inpatient Costs Were Not Significantly Different Between Groups P-OCD $10,000 not significant Median Inpatient Costs ($) P-D $8,932 $8,932 $5,000 $5,791 $5,791 $0 All Inpatient Costs Medical Inpatient Costs 8 Society of General Internal Medicine, 31 st Annual Meeting; April 11, 2008; Pittsburgh, PA
MEDIAN 2-YEAR INPATIENT COSTS Total Inpatient Costs Were Not Significantly Different Between Groups P-OCD $10,000 not significant Median Inpatient Costs ($) P-D $8,932 $8,932 $5,000 $5,791 $5,791 $0 All Inpatient Costs Medical Inpatient Costs 9 Society of General Internal Medicine, 31 st Annual Meeting; April 11, 2008; Pittsburgh, PA
Summary of Results Total Medical Psychiatric Costs Costs Costs Overall Healthcare Costs Inpatient Costs NS NS - Outpatient Costs NS Pharmacy Costs NS 10 Society of General Internal Medicine, 31 st Annual Meeting; April 11, 2008; Pittsburgh, PA
MEDIAN 2-YEAR OUTPATIENT COSTS Total Outpatient Costs Were Significantly Higher in Patients with P-OCD vs P-D $6,000 p<0.0001 Median Outpatient Costs ($) P-OCD p<0.0001 P-D $5,139 $4,820 $3,000 $2,687 $2,525 not significant $224 $220 $0 Total Outpatient Medical Outpatient Psychiatric Costs Costs Outpatient Costs 11 Society of General Internal Medicine, 31 st Annual Meeting; April 11, 2008; Pittsburgh, PA
MEDIAN 2-YEAR OUTPATIENT COSTS Total Outpatient Costs Were Significantly Higher in Patients with P-OCD vs P-D $6,000 p<0.0001 Median Outpatient Costs ($) P-OCD p<0.0001 P-D $5,139 $4,820 Medical (but not Psychiatric) Costs were Significantly $3,000 Higher in Patients with P-OCD vs P-D $2,687 $2,525 not significant $224 $220 $0 Total Outpatient Medical Outpatient Psychiatric Costs Costs Outpatient Costs 12 Society of General Internal Medicine, 31 st Annual Meeting; April 11, 2008; Pittsburgh, PA
Summary of Results Total Medical Psychiatric Costs Costs Costs Overall Healthcare Costs Inpatient Costs NS NS - Outpatient Costs NS Pharmacy Costs NS 13 Society of General Internal Medicine, 31 st Annual Meeting; April 11, 2008; Pittsburgh, PA
MEDIAN 2-YEAR PHARMACY COSTS Total Pharmacy Costs Were Significantly Higher in Patients with P-OCD vs P-D Median Outpatient Costs ($) P-OCD p<0.0001 P-D $6,000 p<0.0001 $5,741 $3,000 $3,294 not significant $2,578 $1,810 $1,346 $818 $0 Total Pharmacy Costs Medical Pharmacy Psychiatric Pharmacy Costs Costs 14 Society of General Internal Medicine, 31 st Annual Meeting; April 11, 2008; Pittsburgh, PA
MEDIAN 2-YEAR PHARMACY COSTS Total Pharmacy Costs Were Significantly Higher in Patients with P-OCD vs P-D Median Outpatient Costs ($) P-OCD p<0.0001 P-D $6,000 Psychiatric (but not Medical) Costs were Significantly p<0.0001 Higher in Patients with $5,741 P-OCD vs P-D $3,000 $3,294 not significant $2,578 $1,810 $1,346 $818 $0 Total Pharmacy Costs Medical Pharmacy Psychiatric Pharmacy Costs Costs 15 Society of General Internal Medicine, 31 st Annual Meeting; April 11, 2008; Pittsburgh, PA
Summary of Results Total Medical Psychiatric Costs Costs Costs Overall Healthcare Costs Inpatient Costs NS NS - Outpatient Costs NS Pharmacy Costs NS * * Antimanics, Antidepressants, Antipsychotics, Anxiolytics, Mood Stabilizers, Sedative/Hypnotics, Stimulants 16 Society of General Internal Medicine, 31 st Annual Meeting; April 11, 2008; Pittsburgh, PA
CONCLUSIONS 17 Society of General Internal Medicine, 31 st Annual Meeting; April 11, 2008; Pittsburgh, PA
CONCLUSIONS: OUTPATIENT COSTS • Although patients were matched on medical illness severity, those with P-OCD had 2 times greater outpatient medical costs than those with P-D. • Findings suggest that care for patients with OCD occurs in the outpatient medical setting Total Medical Psychiatric Costs Costs Costs Overall Healthcare Costs Inpatient Costs NS NS - Outpatient Costs NS Pharmacy Costs NS 18 Society of General Internal Medicine, 31 st Annual Meeting; April 11, 2008; Pittsburgh, PA
CONCLUSIONS: PHARMACY COSTS • P-OCD patients had significantly greater psychotropic costs than those with P-D. This may be attributable to Higher SSRI doses required 4 • More frequent use of concomitant psychotropics 5 • • Inappropriate pharmacologic treatment? Total Medical Psychiatric Costs Costs Costs Overall Healthcare Costs Inpatient Costs NS NS - Outpatient Costs NS Pharmacy Costs NS 19 Society of General Internal Medicine, 31 st Annual Meeting; April 11, 2008; Pittsburgh, PA
CONCLUSIONS • Although a relatively rare disorder, the overall healthcare costs of patients with OCD appear to exceed those of patients with depression • Findings suggest that care for patients with OCD commonly occurs in the outpatient medical setting • Further research is required to determine whether appropriate treatment of OCD improves patient outcomes and reduces costs 20 Society of General Internal Medicine, 31 st Annual Meeting; April 11, 2008; Pittsburgh, PA
BACKUP 21 Society of General Internal Medicine, 31 st Annual Meeting; April 11, 2008; Pittsburgh, PA
METHODS: P-OCD PATIENT IDENTIFICATION No OCD 1 , No Depression, 2 Depression, 2 Bipolar, 3 Bipolar, 3 Psychoses 4 Psychoses 4 1999 2001 2003 2006 1997 1 st OCD diagnosis 1. OCD = ICD-9 300.3 2. Depression = ICD-9 296.2, 296.3, 296.9, 300.4, 309.0, 309.1, 311 3. Psychoses = ICD-9 295, 298 4. Bipolar disorder = ICD-9 296 P-D patients were identified similarly, except index claim was depression and exclusion diagnoses included OCD rather than depression. 22 Society of General Internal Medicine, 31 st Annual Meeting; April 11, 2008; Pittsburgh, PA
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