Initiating Cariprazine as First Adjunctive Therapy Linked to Lower Mental Health Costs in MDD
A recent retrospective study of commercially insured adults with major depressive disorder (MDD) found that patients who initiated cariprazine as their first adjunctive therapy to antidepressant treatment had significantly lower mental health-related health care utilization and costs compared to those who started cariprazine after trying other adjunctive therapies.
Using data from the Merative MarketScan Commercial Database, researchers identified 838 adults with MDD who began cariprazine adjunctive to antidepressant therapy in 2018 or later. Of these, 44.7% received cariprazine as their first adjunctive therapy, while 55.3% initiated it following previous adjunctive treatments.
Patients who started cariprazine first experienced fewer mental health-related hospitalizations and outpatient visits per patient-year compared to those who used it subsequently. The hospitalization rate ratio was 0.55 (95% CI, 0.30–0.90; P = .020), and the outpatient visit rate ratio was 0.67 (95% CI, 0.57–0.82; P < .001). These differences translated into lower mental health-related health care costs.
The total annual mental health-related cost savings per patient for those initiating cariprazine first was $2182 (95% CI, –$4206 to –$69; P = .040), driven primarily by a $1511 reduction in outpatient visit costs (95% C,: –$2330 to –$615; P < .001). Similar patterns were observed in all-cause health care utilization and costs.
“These findings suggest that initiating cariprazine earlier in the treatment sequence may reduce health care resource use and costs in patients with MDD,” the authors wrote.
While the study is limited by its retrospective design and reliance on claims data as a proxy for medication use, the results support considering earlier introduction of cariprazine in patients who do not adequately respond to antidepressants alone. The authors concluded, “Initiating cariprazine as the first adjunctive therapy rather than a subsequent therapy could help mitigate the considerable economic burden of MDD for appropriate patients.”
These findings may be relevant to treatment planning, particularly in the context of cost management and optimizing mental health service utilization among patients with treatment-resistant depression.
Reference
Masand PS, Clayton AH, Parikh M, et al. Healthcare resource utilization and costs of using cariprazine as the first versus subsequent adjunctive therapy for major depressive disorder. J Med Econ. 2025;28(1):235–244. doi:10.1080/13696998.2025.2457872
