A retrospective analysis to estimate the healthcare resource utilization and cost associated with treatment-resistant depression in commercially insured US patients

Abstract

The economic burden of commercially insured patients in the United States with treatmentresistant depression and patients with non-treatment-resistant major depressive disorder was compared using data from the Optum Clinformatics™ claims database. Methods Patients 18-63 years on antidepressant treatment between 1/1/13 and 9/30/13, who had no treatment claims for depression 6 months before the index date (first antidepressant dispensing), and who had a major depressive disorder or depression diagnosis within 30 days of the index date, were included. Treatment-resistant depression was defined as receiving 3 antidepressant regimens during 1 major depressive disorder episode. Patients with treatment-resistant depression were matched with patients with non-treatment-resistant major depressive disorder at a 1:4 ratio using propensity score matching. The study consisted of 1-year baseline (pre-index) and 2-year follow-up (post index) periods. Cost outcomes were compared using a generalized linear model. Results 2,370 treatment-resistant depression and 9,289 non-treatment-resistant major depressive disorder patients were included. In year 1 of the follow-up period, compared with non-treatment-resistant major depressive disorder, patients with treatment-resistant depression had: more emergency department visits (odds ratio = 1.39, 95% confidence interval = 1.24-1.56); more inpatient hospitalizations (odds ratio = 1.73, 95% confidence interval = 1.46-2.05); longer hospital stays (mean difference vs non-treatment-resistant major depressive

Healthcare Resource Consumption and Related Costs of Patients Estimated with Treatment-Resistant Depression in Italy

“…In literature it has been widely reported that TRD patients incur more healthcare expenses and resource use compared to patient with non-TRD depressive syndromes, 9 , 14 and the economic burden significantly increases with the level of resistance. 13 , 15 This tendency was observed in our study as well, by comparing costs over different number of antidepressant lines.…”

“…7,8 Furthermore, TRD patients had higher direct and indirect medical costs than nontreatment-resistant major depressive ones. 9 To the best of our knowledge, there is a lack of data regarding the economic burden of TRD in Italy. In a previous study, we estimated the number of patients affected by TRD in Italy by using selected criteria to identify TRD according to the European Medicines Agency (EMA) definition.…”

“…7 , 8 Furthermore, TRD patients had higher direct and indirect medical costs than non–treatment-resistant major depressive ones. 9 …”

How Far Has Repetitive Transcranial Magnetic Stimulation Come Along in Treating Patients With Treatment-Resistant Depression?

“…According to the United States Agency for Healthcare Research and Quality, TRD is defined as depression that fails to respond to a minimum of two antidepressant treatments administered at an adequate dose and duration [ 4 ]. Researchers have categorized five stages of TRD: Stage zero is those who have not had a single adequate medication trial; Stage I is a failure of adequate trials of one class of antidepressants; Stage II is a failure of adequate trials of two distinctly different classes of antidepressants; Stage III consists failure of adequate trials of two distinctly different classes of antidepressants and failure to respond to one augmentation strategy, such as lithium or thyroid augmentation; Stage IV consists of all the factors of Stage III and includes the failure to respond to a second augmentation strategy such as monoamine oxidase inhibitors; Stage V has all the aspects of Stage IV along with the failure of an adequate course of electroconvulsive therapy.…”

“…From 2010 to 2018, the economic burden of adults with MDD increased by nearly 38%, from $236.6 billion to $326.2 billion [ 3 ]. In 2012 alone, the total burden of MDD exceeded the societal burden of cancer ($131 billion) and diabetes ($173 billion) [ 4 ]. The economic burden associated with MDD comes in part from the treatment methods involved in managing MDD patients.…”