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Saturday, September 8, 2012

Medicare Patient Experience with Vagus Nerve Stimulation for Treatment-Resistant Depression.

2012 Sep 6. [Epub ahead of print]

Medicare Patient Experience with Vagus Nerve Stimulation for Treatment-Resistant Depression.


Abstract Background: Major depressive disease (MDD) represents a cost burden to the US healthcare system: approximately one-third of MDD patients fail conventional treatment: multiple failures define treatment-resistant depression (TRD). Vagus nerve stimulation (VNS) therapy is an approved adjunctive treatment for TRD. Objective: To study the healthcare utilization experience of Medicare beneficiaries implanted with VNS (VNSBs) during Medicare coverage, compared with beneficiaries with TRD (TRDBs) and managed depression (Mdeps). Methods: A retrospective analysis of 100% standard analytic file (SAF) Medicare claims from 2006-2009 using specific criteria to identify a VNSB dataset, compared to TRDs and Mdeps datasets (extract of 5% sample SAF from 2001-2009) and 2009 general Medicare beneficiaries (GMBs). Comparative analysis included demographics, mortality, healthcare utilization and costs. Results: Among patients meeting study criteria for VNSBs (N=690), TRDBs (N=4,639), Mdeps (N=7,524), and GMBs (N>36 million), VNSBs were on average: younger, more likely to be female and white, with Medicare eligibility due to disability. Of the VNSBs in the 2-year post-implantation period: 5% died; 22% experienced no negative events (defined as hospitalizations for psychoses or poisoning, emergency room use, electroconvulsive therapy, or poisoning, suicidal ideation, or self-harm diagnoses); 29% experienced multiple negative events; and 41% had either a single hospitalization or only all-cause ER visits. VNSBs experiencing negative events had more complex co-occurring psychiatric diagnoses. The annual mortality rate for VNSBs post-implant was 13.9 deaths per 1,000 patient years, compared with 46.2 (CI: 41.9-51.6) and 46.8 (CI: 43.4-50.4) deaths for TRDBs and Mdeps, respectively. The medical costs per patient-year post-VNS implantation for VNSBs ($8,749) was similar to the Mdeps ($8,960; CI $8,555-$9,381) and was substantially lower than TRDBs ($13,618; CI $12,937-$14,342). Conclusions: VNSBs achieving positive health outcomes (measured by lack of negative events post-implantation) tend to have fewer psychiatric co-occurring conditions. Lowered costs post-implantation with evidence of response to VNS suggest the therapy represents an option for carefully screened TRDBs who have failed other therapies. Limitations: Administrative data are missing pharmaceuticals and clinical measures. Data for the VNS population were not available pre-implantation for comparison to post-implantation experience. Cost comparisons are adjusted for missing costs in VNS dataset.
[PubMed - as supplied by publisher]

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