Healthcare resource utilization with adjunctive cariprazine and other atypical antipsychotics in patients with major depressive disorder

Little is known about the healthcare resource utilization (HRU) associated with different adjunctive atypical antipsychotics (AAs) for the treatment of major depressive disorder (MDD). This analysis evaluated HRU in patients with MDD treated adjunctively with cariprazine versus other AAs. Merative MarketScan databases were searched for claims made from 01/01/2018 to 12/31/2020 (Medicaid) or 3/31/2021 (commercial and Medicare). The study included adults with ≥1 inpatient MDD claim or ≥2 outpatient MDD claims &gt;30 days apart and ≥1 claim for cariprazine, brexpiprazole, generic aripiprazole, or generic quetiapine adjunctive to an antidepressant (i.e. ≥14-day overlap between AA and antidepressant). Outcomes included all-cause and MDD-related inpatient stays and emergency department (ED), office, and psychiatric visits. Results were reported as estimated mean ratios, calculated <i>via</i> negative binomial regression, of the comparator AA to cariprazine with 95% CIs. Analyses included 40,195 patients (cariprazine [<i>n</i> = 1,038], brexpiprazole [<i>n</i> = 3,221], generic aripiprazole [<i>n</i> = 20,601], generic quetiapine [<i>n</i> = 15,335]). The cariprazine cohort had significantly fewer all-cause and MDD-related inpatient stays relative to all other AA cohorts. All-cause ED visits were significantly lower in the cariprazine versus generic quetiapine cohort, and MDD-related ED visits were significantly lower in the cariprazine versus generic aripiprazole and generic quetiapine cohorts. ED visits were similar between cariprazine and all other cohorts. All-cause and MDD-related office and psychiatric visits were significantly lower in the cariprazine versus most other AA cohorts. Although causality cannot be determined from these real-world findings, results suggest that in patients with MDD, initiating adjunctive cariprazine is associated with significantly lower HRU for certain outcomes relative to other AAs. Patients with major depressive disorder (MDD) often use healthcare resources, such as going to the doctor. Cariprazine is an atypical antipsychotic that can be used with antidepressants to treat MDD. This study looked at the different amounts of healthcare resources patients used based on which medication they took with their antidepressant. Insurance databases were used to find adults with MDD prescribed atypical antipsychotics with antidepressants. We then compared the number of times patients went to the hospital, emergency department, or doctor’s office based on if they started cariprazine, brexpiprazole, generic aripiprazole, or generic quetiapine. Patients who started cariprazine went to the hospital less than those who started other drugs. Patients who started cariprazine also went to the emergency department for any reason less than those who started generic quetiapine. Also, patients who started cariprazine went to the emergency department for MDD reasons less than patients who started generic aripiprazole or quetiapine. Last, patients who started cariprazine went to the doctor’s office less than those who started most of the other drugs. Our results suggest that treatment of MDD with an antidepressant and cariprazine is associated with less use of healthcare resources than treatment with other atypical antipsychotics.