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The impact of Medicaid expansion in 2014 on prescription second-generation antidepressant utilization in Washington State: An interrupted time series analysis

Lindstedt, Paulina LU (2018) MPHN40 20181
Social Medicine and Global Health
Abstract
Background
Depressive disorders, specifically major depressive disorder (MDD), is predicted to become the leading cause of disease burden worldwide by 2030. In the United States, MDD is already the leading cause of disability. Yet, less than 50 percent of US adults diagnosed with a mental disorder seek treatment, often due to lack of health coverage or affordability. In 2014, the Affordable Care Act expanded Medicaid eligibility in select states to extend health and medication coverage to previously uninsured Americans. Medicaid expansion has been shown to increase medication use in expansion states, however, few studies have examined how Medicaid expansion has impacted a specific drug class such as second-generation antidepressants. This... (More)
Background
Depressive disorders, specifically major depressive disorder (MDD), is predicted to become the leading cause of disease burden worldwide by 2030. In the United States, MDD is already the leading cause of disability. Yet, less than 50 percent of US adults diagnosed with a mental disorder seek treatment, often due to lack of health coverage or affordability. In 2014, the Affordable Care Act expanded Medicaid eligibility in select states to extend health and medication coverage to previously uninsured Americans. Medicaid expansion has been shown to increase medication use in expansion states, however, few studies have examined how Medicaid expansion has impacted a specific drug class such as second-generation antidepressants. This study looked at the impact of Medicaid expansion on antidepressant utilization in Washington State, a state that participated in expansion and reports one of the highest rates of depression in the U.S.
Objective
The objective of this study was to evaluate second-generation antidepressant utilization measured by number of prescriptions filled before and after Medicaid expansion in 2014, while also accounting for known increases in Medicaid enrollment.
Methods
An interrupted time series analysis was conducted using Medicaid state drug utilization data from 2011 to 2016. The primary outcome was changes in quarterly antidepressant use before and after Medicaid expansion in Washington. The secondary outcome was per-member-per-quarter (PMPQ) antidepressant utilization before and after expansion, which accounted for the increase in Medicaid enrollees.
Results
Washington experienced a significant trend increase in antidepressant utilization after Medicaid expansion. Specifically, total utilization increased by 14,912 prescriptions per quarter after expansion (p < .001) and PMPQ utilization increased by .008 (p < .05) after expansion compared to the pre-expansion utilization trend.
Conclusions
Study results suggest that prescription second-generation antidepressant use increased in Washington after full Medicaid expansion in 2014, partly due to the influx of new enrollees. (Less)
Popular Abstract
Full Medicaid Expansion in 2014 Increased Outpatient Prescription Second-Generation Antidepressant Use in Washington State

Major depressive disorder is the leading cause of disability in the United States and is predicted to rise to the leading cause of disease burden worldwide by 2030. Though the social, familial and economic impacts of depression are a rising cause for public health concern, many American’s with mental health disorders lack health coverage and access to affordable treatment. Within the U.S., Washington State has some of the highest rates of depression and has been rated poorly for access to mental health treatment. When Washington decided to participate in the Medicaid expansion provision of the Affordable Care Act... (More)
Full Medicaid Expansion in 2014 Increased Outpatient Prescription Second-Generation Antidepressant Use in Washington State

Major depressive disorder is the leading cause of disability in the United States and is predicted to rise to the leading cause of disease burden worldwide by 2030. Though the social, familial and economic impacts of depression are a rising cause for public health concern, many American’s with mental health disorders lack health coverage and access to affordable treatment. Within the U.S., Washington State has some of the highest rates of depression and has been rated poorly for access to mental health treatment. When Washington decided to participate in the Medicaid expansion provision of the Affordable Care Act (ACA) that was implemented on January 1, 2014, it aimed at decreasing the uninsured rate and some barriers to health care. This study looked at the impact of Medicaid expansion in 2014 on prescription antidepressant utilization as measured by number of prescriptions filled from 2011 to 2016.

This study found that Medicaid expansion was associated with an increase in antidepressant use in Washington. These findings indicate that Medicaid expansion extended access to antidepressant drug services to previously uninsured, low-income Washington residents. However, additional increases in antidepressant utilization was found beyond what could be expected because of increased enrollment alone. This added increase suggests that other factors may have also played a role in the increase of antidepressant utilization within the entire Medicaid population between 2014 and 2016. For instance, other stipulations included in the ACA, increasing public awareness of mental health disorders and an increase in available antidepressant medications covered under Washington’s Medicaid program may have also contributed to increased antidepressant use. Future studies should consider these other factors as well as including a comparison state or states and years prior to early Medicaid expansion to gain a more comprehensive understanding of the impact of Medicaid expansion on antidepressant utilization in Washington. (Less)
Please use this url to cite or link to this publication:
author
Lindstedt, Paulina LU
supervisor
organization
course
MPHN40 20181
year
type
H2 - Master's Degree (Two Years)
subject
keywords
Medicaid expansion, Affordable Care Act, Antidepressants
language
English
id
8954673
date added to LUP
2018-07-17 14:53:14
date last changed
2018-07-17 14:53:14
@misc{8954673,
  abstract     = {Background
Depressive disorders, specifically major depressive disorder (MDD), is predicted to become the leading cause of disease burden worldwide by 2030. In the United States, MDD is already the leading cause of disability. Yet, less than 50 percent of US adults diagnosed with a mental disorder seek treatment, often due to lack of health coverage or affordability. In 2014, the Affordable Care Act expanded Medicaid eligibility in select states to extend health and medication coverage to previously uninsured Americans. Medicaid expansion has been shown to increase medication use in expansion states, however, few studies have examined how Medicaid expansion has impacted a specific drug class such as second-generation antidepressants. This study looked at the impact of Medicaid expansion on antidepressant utilization in Washington State, a state that participated in expansion and reports one of the highest rates of depression in the U.S.
Objective
The objective of this study was to evaluate second-generation antidepressant utilization measured by number of prescriptions filled before and after Medicaid expansion in 2014, while also accounting for known increases in Medicaid enrollment.
Methods
An interrupted time series analysis was conducted using Medicaid state drug utilization data from 2011 to 2016. The primary outcome was changes in quarterly antidepressant use before and after Medicaid expansion in Washington. The secondary outcome was per-member-per-quarter (PMPQ) antidepressant utilization before and after expansion, which accounted for the increase in Medicaid enrollees.
Results
Washington experienced a significant trend increase in antidepressant utilization after Medicaid expansion. Specifically, total utilization increased by 14,912 prescriptions per quarter after expansion (p < .001) and PMPQ utilization increased by .008 (p < .05) after expansion compared to the pre-expansion utilization trend.
Conclusions
Study results suggest that prescription second-generation antidepressant use increased in Washington after full Medicaid expansion in 2014, partly due to the influx of new enrollees.},
  author       = {Lindstedt, Paulina},
  keyword      = {Medicaid expansion,Affordable Care Act,Antidepressants},
  language     = {eng},
  note         = {Student Paper},
  title        = {The impact of Medicaid expansion in 2014 on prescription second-generation antidepressant utilization in Washington State: An interrupted time series analysis},
  year         = {2018},
}