Burden of Treatment Resistant Depression (TRD) in patients with major depressive disorder in Ontario using Institute for Clinical Evaluative Sciences (ICES) databases: Economic burden and healthcare resource utilization

McIntyre, Roger S.; Millson, Brad; Power, G Sarah

doi:10.1016/j.jad.2020.07.045

Cited by 29 publications

(23 citation statements)

References 31 publications

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“…However, several studies observed hospitalization costs to consistently increase disproportionately to other costs. 15,16 Our cohort of patients reflected real clinical practice, and the results must be interpreted taking into account the limitations related to the observational nature of the study, which was based on data collected from administrative databases. First, there is not a consensus definition for TRD, therefore we could have over-or underestimated the number of TRD patients.…”

Section: Discussionmentioning

confidence: 99%

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

Perrone¹,

Sangiorgi²,

Andretta³

et al. 2021

CEOR

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To analyse the healthcare resource consumption and related costs for the Italian National Health System of patients estimated to be affected by treatment-resistant depression (TRD) in Italy. Patients and Methods: This was an observational retrospective study based on administrative databases, including those related to residential/semiresidential structures, of Veneto Region and the Local Health Unit of Bergamo in Italy (for a total of around 6 million healthassisted subjects). Between July 2011 and December 2017, all adult patients with a third antidepressant (AD) after ≥2 AD (each one with at least ≥4 weeks duration, ≥1 prescription at maximum dosage reported in datasheets, a grace period ≤30 days when switching AD and treatment maintained ≥9 months) were included. Overall and psychiatry-related healthcare resources consumption and related costs were estimated on a 12-months based analysis. Data were re-proportioned to the Italian population. Results: We have previously estimated a total of 101,455 patients with TRD in Italy (130,049 considering the mean maximum dosage of AD). Of them, 44.2% had at least a psychiatric hospitalization/visit or accessed a residential/semiresidential structure, and 31% added another AD or a mood stabilizer/antipsychotic drug. Patients with at least one psychiatryrelated hospitalization increased over the number of antidepressant lines from 12.0% during first line up to 24.5% during fourth line. Direct healthcare costs increased from €4,405 for first line to €9,251 from fifth line onwards. Psychiatry-related costs went from €1,817 (first line) to €4,606 (fifth line onwards) and were mainly driven by residential/semiresidential structures and hospitalizations. Conclusion:An upward trend with number of AD lines was observed for all healthcare resource utilization and consequently for all direct costs, thus indicating an increasing burden for patients as they move forward AD lines.

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Section: Discussionmentioning

confidence: 99%

“…However, several studies observed hospitalization costs to consistently increase disproportionately to other costs. 15 , 16 …”

Section: Discussionmentioning

confidence: 99%

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

Perrone¹,

Sangiorgi²,

Andretta³

et al. 2021

CEOR

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“…The natural course of TRD is severe and often fatal [ 1 ]. Yet, there is still inertia in adopting emerging and novel therapies into practice.…”

Section: Barriers To Treatmentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Depression has a substantial impact on the emotional and functional well-being of those living with the condition, as well as their loved ones [ 1 ]. The impact of depression is well described in the literature, and it is most prominent in patients who have gone through multiple treatments without success [ 1 ]. Treatment-resistant depression (TRD) is particularly debilitating, and is defined in the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM5), as inadequate response to two or more antidepressant trials of adequate doses and duration [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

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Role of the Pharmacist in Managing Treatment-Resistant Depression: A Focus on Ketamine

2021

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The impact of depression is well described in the literature, and it is most prominent in patients who have trialed multiple treatments. Treatment-resistant depression (TRD) is particularly debilitating, and it is associated with significant morbidity and mortality. Despite this, there seems to be therapeutic inertia in adopting novel therapies in current practice. Ketamine is an N-methyl-D-aspartate receptor antagonist and anesthetic agent which has recently been shown to be effective in the management of TRD when administered intravenously or intranasally. The treatments, however, are not easily accessible due to restrictions in prescribing and dispensing, high costs, and the slow uptake of evidence-based practice involving ketamine within the Canadian healthcare system. Given the limited treatment options for TRD, novel approaches should be considered and adopted into practice, and facilitated by a multi-disciplinary approach. Pharmacists play a critical role in ensuring access to quality care. This includes dissemination of evidence supporting pharmacological treatments and facilitating translation into current practice. Pharmacists are uniquely positioned to collaborate with prescribers and assess novel treatment options, such as ketamine, address modifiable barriers to treatment, and triage access to medications during transitions of care. Extending the reach of these novel psychiatric treatments in both tertiary and primary care settings creates an emerging role for pharmacists in the collaborative effort to better manage treatment-resistant depression.

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A Multifunctional Nanocarrier System for Highly Efficient and Targeted Delivery of Ketamine to NMDAR Sites for Improved Treatment of Depression

Tan

Gao

et al. 2023

Adv Healthcare Materials

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Ketamine (KA), commonly used as an anesthetic, is now widely studied as an antidepressant for the treatment of depression. However, due to its side effects, such as addiction and cognitive impairment, the dosage and frequency of (S)‐ketamine approved by the FDA for the treatment of refractory depression is very low, which limits its efficacy. Here, a new multifunctional nanocarrier system (AC‐RM@HA‐MS) with specific targeting capabilities is developed to improve the efficacy of KA treatment. KA‐loaded NPs (AC‐RM@HA‐MS‐KA) are constructed with a multilayer core–shell structure. KA‐loaded mesoporous silica NPs are prepared, conjugated with hyaluronic acid (HA) as pore gatekeepers, and sheathed with an RBC‐membrane (RM) for camouflage. Finally, the surface is tagged with bifunctional peptides (Ang‐2‐Con‐G, AC) to achieve specific targeting. One peptide (Ang‐2) is acted as a guide to facilitate the crossing of the blood–brain barrier (BBB), while the other (Con‐G) is functioned as a ligand for the targeted delivery of KA to the N‐methyl‐D‐aspartate receptor sites. Animal experiments reveal that AC‐RM@HA‐MS‐KA NPs effectively cross the BBB and directionally accumulate in the curing areas, thereby alleviating the depressive symptoms and improving the cognitive functions of depressed mice. After treatment, the depressed mice almost completely return to normal without obvious symptoms of addiction.

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Burden of Treatment Resistant Depression (TRD) in patients with major depressive disorder in Ontario using Institute for Clinical Evaluative Sciences (ICES) databases: Economic burden and healthcare resource utilization

Cited by 29 publications

References 31 publications

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

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

Role of the Pharmacist in Managing Treatment-Resistant Depression: A Focus on Ketamine

A Multifunctional Nanocarrier System for Highly Efficient and Targeted Delivery of Ketamine to NMDAR Sites for Improved Treatment of Depression

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