Abstract
The economic burden of commercially insured patients in the United States with treatment-resistant depression and patients with non-treatment-resistant major depressive disorder was compared using data from the Optum Clinformatics™ claims database. 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. 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 disorder = 2.86, 95% confidence interval = 0.86-4.86 days); and more total healthcare costs (mean difference vs non-treatment-resistant major depressive disorder = US$3,846, 95% confidence interval = $2,855-$4,928). These patterns remained consistent in year 2 of the follow-up period. Treatment-resistant depression was associated with higher healthcare resource utilization and costs versus non-treatment-resistant major depressive disorder in this commercially insured cohort of patients in the United States.
Highlights
Depression is a widespread, severely disabling disorder associated with impaired daily functioning, diminished quality of life, and increased mortality and healthcare utilization [1,2,3,4]
Results from Sequenced Treatment Alternatives to Relieve Depression (STAR D) suggest that nonresponse to 2 adequate trials of established pharmacotherapy classes is an inflection point that predicts a poor prognosis with respect to low remission and high relapse rates, and is associated with higher rates of future medication intolerance [5,13]
Medical costs to patients were defined as the sum of deductibles, copayments, and coinsurance for all medical services; prescription costs to patients were defined as the sum of deductibles, copayments, and coinsurance for all prescription drugs; and total costs to patients were the sum of medical costs and prescription costs to patients
Summary
Depression is a widespread, severely disabling disorder associated with impaired daily functioning, diminished quality of life, and increased mortality and healthcare utilization [1,2,3,4]. Healthcare costs such as outpatient medical services, pharmaceutical services, and inpatient services as well as indirect costs such as workplace presenteeism and absenteeism all contribute substantially towards the total burden of major depressive disorder [3]. No consensus definition currently exists, the US Agency for Healthcare Research and Quality (AHRQ) and Food and Drug Administration (FDA) proposed a standard definition of treatment-resistant depression: failing to respond to a minimum of 2 antidepressants administered at an adequate dose, for an adequate duration [8,9]. Results from STAR D suggest that nonresponse to 2 adequate trials of established pharmacotherapy classes is an inflection point that predicts a poor prognosis with respect to low remission and high relapse rates, and is associated with higher rates of future medication intolerance [5,13]
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