Open AccessGeneric escitalopram initiation and substitution among Medicare beneficiaries: A new user cohort study
Author(s) -
Chao Li,
Li Chen,
Nan Huo,
Ahmed Ullah Mishuk,
Richard A Hansen,
Ilene Harris,
Zippora Kiptanui,
Weide Zhong,
Jingjing Qian
Publication year - 2020
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0232226
Subject(s) - escitalopram , medicine , medical prescription , retrospective cohort study , proportional hazards model , generic drug , hazard ratio , psychiatry , pharmacology , antidepressant , drug , confidence interval , anxiety
Objectives To examine patterns of generic escitalopram initiation and substitution among Medicare beneficiaries. Methods This retrospective new user cohort used a 5% random sample of 2013–2015 Medicare administrative claims data. Fee-for-service Medicare beneficiaries continuously enrolled in Parts A, B, and D during a 6-month washout period prior to their initial generic or brand oral escitalopram prescriptions were included (n = 12,351). The primary outcomes were generic escitalopram treatment initiation, and among brand escitalopram initiators, generic substitution within 12 months. Patient demographics, health service utilization, and prescription level factors were measured and assessed. Results Among all escitalopram initiators, about 88.2% Medicare beneficiaries initiated generic escitalopram. Beneficiaries who were younger age, male, residing in non-Northeast regions or urban area, in the Part D plan deductible benefit phase, and filling prescriptions at community/retail pharmacies were more likely to initiate generic treatment. Among brand escitalopram initiators (n = 1,464), about 20.7% switched to generic escitalopram, 31.2% switched to another alternative antidepressant, 25.1% discontinued treatment, and 8.7% were lost to follow up or passed away within 12 months after brand initiation. Factors associated with generic escitalopram substitution included region (Midwest vs. Northeast, adjusted hazard ratio (HR) = 1.46, 95% CI = 1.04–2.05), pre-index hospitalization (HR = 1.31; 95% CI = 1.16–1.48) and lower escitalopram average daily dosage (HR = 0.97; 95% CI = 0.95–0.99). Conclusions In 2013–2015, almost 90% Medicare beneficiaries initiated generic escitalopram treatment. Among brand escitalopram initiators, about 1 in 5 patients switched to generic escitalopram within 1 year, as compared to 1 in 4 or 1 in 3 who discontinued current or switched to alternative treatment, respectively. Medicare beneficiary’s geographic region was independently associated with generic escitalopram initiation and substitution. Findings from this study not only provide up-to-date evidence in generic escitalopram use patterns among Medicare population, but also can guide educational and practice interventions to further increase generic escitalopram use.