Real-World Treatment Patterns, Outcomes, Resource Utilization and Costs in Treatment-Resistant Major Depressive Disorder: PATTERN, a Retrospective Cohort Study in Belgium

Abstract

Objective Treatment-resistant depression (TRD), a subgroup of major depressive disorder (MDD) that does not adequately respond to treatment, has a substantial impact on the quality of life of patients and is associated with higher medical and mental health care costs. This study aimed to report real-world treatment patterns, outcomes, resource utilization, and costs in the management of TRD by psychiatrists in Belgium. Methods We conducted a retrospective, non-interventional cohort study of patients ≥ 18 years, with diagnosed MDD who are treatment-resistant, defined as not responding to two different antidepressant treatments in the current moderate to severe major depressive episode (MDE). Data obtained from medical records of patients included patient health state (MDE, response, remission, and recovery) and resource use (number of consultations and emergency room visits, non-drug and drug interventions, and hospitalizations). Results One hundred and twenty-five patients were enrolled in nine sites, with an average observation period of 34 months. During the MDE, 89.7% of patients were treated with selective serotonin reuptake inhibitors, 63.2% with serotonin-norepinephrine reuptake inhibitors, and 60.8% with anti-psychotics. Twenty-four percent of patients did not respond to any treatment; 76% responded, of whom 61% experienced a relapse; 28% of patients reached recovery, of whom 31.4% experienced recurrence. The average yearly direct cost of a TRD patient is €9012, mainly driven by hospitalization in the MDE. The observed absenteeism relates to a high indirect cost, representing 70% of the total MDE cost. Conclusion TRD is associated with a high unmet need and economic burden for patients and society, with highest costs in the MDE health state driven by absenteeism. Supplementary Information The online version contains supplementary material available at 10.1007/s41669-021-00306-2.

Care pathways, prescribing practices and treatment outcomes in major depressive disorder and treatment-resistant depression: retrospective, population-based cohort study

“…Likewise, over a 2 year follow-up period, Gillain and colleagues found that of 95 patients who achieved response or remission, 61% relapsed. 23 …”

Economic evaluation of interventions for treatment-resistant depression: A systematic review

“…In the context of TRD, a short time horizon may underestimate the cost effectiveness of an intervention by failing to account for smaller incremental improvements in mental health (accruing substantially with a longer horizon), or the improvements that persist beyond the evaluation horizon – for example, MDD patients receiving cognitive therapy have been found to exhibit reduced relapse rates for up to 6 years ( 78 ). Conversely, bearing in mind the highly recurrent nature of TRD over periods of up to 36 months ( 105 , 106 ), cost effectiveness might be overestimated through censoring of relapse or recurrence events. Extrapolation implicitly introduces additional uncertainty into the model, but one must balance the impact of that additional uncertainty on results against the benefits of decision support that reflects the longer-term costs and consequences of the intervention in question.…”

Cost-Utility Analysis of Esketamine for Patients with Treatment-Resistant Depression in Italy

“…The details of the search strategy are reported in the ESM (Appendix 3). The study by Taipale and colleagues [ 33 ] reported 100.1 days lost for TRD in a period of 8 months; a European study reported a working time loss of 57% [ 27 ], while another study conducted in Belgium [ 34 ] showed an average number of calendar days ‘not working’ per month of 22.2 during a major depressive episode. A study conducted in Italy [ 35 ] reported a mean of 42 working days lost per year for patients with TRD, while a study conducted in the UK showed an overall work impairment of 51% for those patients [ 36 ].…”