Abstract
Summary
Despite demonstrated differences in toxicity profiles between tricyclic antidepressants (TCAs) and selective serotonin (5-hydroxytryptamine; S-HT) reuptake inhibitors (SSRIs), no studies have examined hospital costs associated with acute antidepressant overdoses. Given the high incidence of such overdoses, it is important to examine treatment patterns and associated costs. This prospective, multicentre cohort study compared the hospital and physician costs associated with TCA and fluoxetine drug overdoses.
Over a 30-month period, 622 consecutive patients with a fluoxetine or TCA overdose presented to the emergency departments. or were admitted to intensive care or medical units. of9 participating medical centres across the US. Inclusion criteria were: ingestion of a single antidepressant (fluoxetine or a TCA), without clinically significant co-ingestants; laboratory confirmation of the overdose; and retrievable hospital bills. Patients were followed until discharge from the emergency department or hospital.
Hospital and physician charges were collected from billing data. Hospital charges were adjusted using Health Care Financing Administration cost: charge ratios to estimate costs; physician charges were adjusted to estimate costs. Patient demographic and clinical data were prospectively gathered during the course of medical treatment. Clinical data recorded included level of consciousness, cardiopulmonary complications. vital sign or ECG abnormalities. agitation. seizures, CNS depression and death.
136 patients (121 with TCA overdose and IS with fluoxetine overdose), representing 21.8% of the 622 patients entered, met the inclusion criteria. Mean length of stay varied from 0.73 [± standard error of the mean (SEM) 0.33] days for fluoxetine overdose patients to 3.59 ( SEM 0.48) days for TCA overdose patients (p = 0.038). Mean hospital costs were $US668 for patients with a fluoxetine overdose compared with $US4691 for those with a TCA overdose (p > 0.0001). No significant differences were observed between the TCA and fluoxetine overdose groups with regard to physician costs. Median hospital and physician costs increased from $US3029 to $US4396 from the first IS-month period of the study to the second 15-month period of the study for the TCA overdose group. but decreased from $US881 to $US396 for the fluoxetine overdose group.
Patients with fluoxetine overdoses had lower hospital and total medical costs compared with patients with TCA overdoses. There was some evidence supporting a reduction in the medical costs of treating fluoxetine overdoses over the 3D-month study period.
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References
Kessler RC, McGonagle KA, Zhao S, et al. Lifetime and 12-months prevalence of DSM-III-R psychiatric disorders in the United States: results fonn the National Comorbidity Survey. Arch Gen Psychiatry 1994; 51: 8–19
Greenberg PE, Stiglin LE, Finkelstein SN, et al. The economic burden of depression in 1990. J Clin Psychiatry 1993; 54: 405–18
Guze SB, Robins E. Suicide among primary affective disorders. Br J Psychiatry 1970; 117: 437–8
Brent DA, Kupfer DJ, Bromet EJ, et al. The assessment and treatment for patients at risk for suicide. In: Frances AJ, Hale RE, editors. Review of psychiatry VII. Washington, DC: American Psychiatric Press, 1988: 353–86
Bulik CM, Carpenter LL, Kupfer DJ, et al. Features associated with suicide attempts in recurrent major depression. J Affect Disord 1990; 18: 29–37
Kapour S, Mieczkowski T, Mann JJ. Antidepressant medications and the relative risk of suicide attempt and suicide. JAMA 1992; 268: 3441–5
Frommer DA, Kulig KW, Marx JA, et al. Tricyclic antidepressant overdose: a review. JAMA 1987; 257 (4): 521–6
Litovitz TL, Holm KC, Clancy C, et al. 1992 Annual Repon of the American Association of Poison Control Centers Toxic Exposures Surveillance System. Am J Emerg Med 1993; 11 (5): 494–555
Cassidy S, Henry J. Fatal toxicity of antidepressant drugs in overdose. BMJ 1987; 295: 1021–4
Farmer RD, Pinder RM. Why do fatal overdose rates vary between antidepressants? Acta Psychiatr Scand 1989; 354 Suppl.: 25–35
Linakis JG, Frederick KA. Poisoning deaths not reponed to the regional poison control center. Ann Emerg Med 1993; 22: 1822–8
Jick SS, Dean AD, Jick H. Antidepressants and suicide. BMJ 1995; 310: 215–8
Isacsson G, Holmgren P, Wasserman D, et al. Use of anti de pressants among people committing suicide in Sweden. BMJ 1994; 308: 506–9
Roy TM, Ossorio MA, Cipolla LM, et al. Pulmonary complications after tricyclic antidepressant overdose. Chest 1989; 96: 852–6
Borys DJ, Setzer SC, Ling LJ, et al. Acute f1uoxetine overdose: a repon of 234 cases. Am J Emerg Med 1992; 10: 115–20
McCombs JS, Nichol MB, Stimmel GL, et al. The cost of antidepressant drug therapy failure: a study of antidepressant use patterns in a Medicaid population. J Clin Psychiatry 1990; 51: 60–9
Phillips S, Brent J, Kulig K, et al. Fluoxetine versus tricyclic antidepressants. A prospective multicenter study of antidepressant drug overdoses: the clinical perspective [abstract]. Vet Human Toxicol 1994; 36: 378
U.S. Depanment of Health and Human Services. Health Care Financing Administration. Health care financing review: Medicare and Medicaid statistical supplement. Baltimore: Office of Research and Demonstrations. 1995
Conover WJ. Practical nonparametric statistics. 2nd ed. New York: John Wiley & Sons, 1980
Mondragon D. Hospital costs of societal violence. Arizona 1989. Med Care 1992; 30: 453–60
Washington State Depanment of Health. An assessment of suicide in Washington State. Olympia, WA: Washington State Injury Prevention Program. Washington State Depanment of Health, Jun 1994: 1–15
Palmer CS, Revicki DA, Halpern MT, et al. The cost of suicide and suicide attempts in the United States. Clin Neuropharmacol 1995; 18 Suppl.3: 525–33
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Revicki, D.A., Palmer, C.S., Phillips, S.D. et al. Acute Medical Costs of Fluoxetine versus Tricyclic Antidepressants. Pharmacoeconomics 11, 48–55 (1997). https://doi.org/10.2165/00019053-199711010-00006
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DOI: https://doi.org/10.2165/00019053-199711010-00006