The 6-month persistence on SSRIs and associated economic burden

J Med Econ. 2010;13(3):527-36. doi: 10.3111/13696998.2010.511050.


Objectives: To assess persistence on SSRIs (most prescribed antidepressants) and associated healthcare costs in a naturalistic setting.

Methods: For this retrospective cohort study based on a US reimbursement claims database, all adults with a claim for a SSRI (citalopram, escitalopram, fluoxetine, paroxetine or sertraline) related to a diagnosis of depression were included. Patients should have had no previous reimbursement for any antidepressant within the previous 6 months. Non-persistence was defined as failing to renew prescription within 30 days in the 6-month period after the index date.

Results: In the 45,481 patients included, persistence decreased from 95.5% at 1 month, to 52.6% at 2 months, 37.6% at 3 months and 18.9% at 6 months. Among factors associated with higher 6-month persistence were age 18-34 years, physician's specialty, treatment with escitalopram, absence of abuse history and psychotropic prescription history. During the 6-month after index date, healthcare costs tended to be higher in non-persistent than in persistent patients although not significantly (RR=1.05, adjusted p=0.055).

Conclusion: Despite some limitations associated with the use of computerized administrative claims data (residual unmeasured confounding), these results highlight a generally low persistence rate at 6 months. Special attention should be given to persistence on treatment, with consideration of potential antidepressant impact.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Antidepressive Agents, Second-Generation / administration & dosage
  • Antidepressive Agents, Second-Generation / economics
  • Depressive Disorder / drug therapy*
  • Depressive Disorder / economics*
  • Female
  • Health Care Costs
  • Health Services / economics*
  • Health Services / statistics & numerical data
  • Humans
  • Insurance Claim Review
  • Insurance, Health, Reimbursement / economics
  • Insurance, Health, Reimbursement / statistics & numerical data
  • Male
  • Medication Adherence
  • Middle Aged
  • Outcome Assessment, Health Care
  • Retrospective Studies
  • Selective Serotonin Reuptake Inhibitors / administration & dosage*
  • Selective Serotonin Reuptake Inhibitors / economics*
  • Young Adult


  • Antidepressive Agents, Second-Generation
  • Serotonin Uptake Inhibitors