Abstract
BackgroundTo determine the incidence of Treatment-Resistant Depression (TRD) in Spain and to estimate its economic burden, using real world data. MethodsA retrospective, observational-study was carried out using data from the BIG-PAC database®. Patients aged ≥18 years with a diagnosis of major depressive-disorder (MDD) who initiated a new antidepressant treatment in 2015–2017 were included. The patients were classified as TRD and non-TRD. Patients were classified as TRD if they had, during the first year of antidepressant treatment: a) failure with ≥2 antidepressants including the prescription of ≥3 antidepressants (N06A) or ≥2 antidepressant and ≥1 antipsychotic (N05A; including lithium) b) antidepressants administered for ≥ 4 weeks each, and c) the time between the end of one treatment and the initiation of the next was ≤ 90 days. Inherent limitations of data collection from databases should also be considered in this analysis (e.g., lack of information about adherence to treatment). Follow-up period: 18 months. The incidence rate was calculated as the number of TRD patients per 1,000 persons-year divided by the population attended. Outcomes: direct healthcare and indirect costs. Two sensitivity analyses were performed varying the index date and the period used to define TRD patients (6 vs.12 months). Results21,630 patients with MDD aged ≥ 18 years (mean age: 53.2 years; female: 67.2%) were analyzed, of whom 3,559 met TRD criteria, yielding a 3-year cumulative incidence of 16.5% (95%CI: 16%-17%) among MDD patients. The annual population incidence rate of TRD in 2015–2017, was 0.59, 1.02 and 1.18/1,000 person-years, respectively (mean: 0.93/1,000 person-year). Overall, mean total costs per MDD patient were €4,147.9, being higher for TRD than for non-TRD patients (€6,096 vs. €3,846; p<0.001): a) direct costs (€1,341 vs. €624; p<0.001), b) lost productivity (€1,274 vs. €821; p<0.001) and c) permanent disability (€3,481 vs. €2,401; p<0.001, adjusted). Sensitivity analyses showed no differences with the reported results. ConclusionsThe population based TRD incidence in Spain was similar to recent data from other European countries. TRD is associated with greater resource use and higher costs compared with non-TRD patients.
Highlights
To determine the incidence of Treatment-Resistant Depression (TRD) in Spain and to estimate its economic burden, using real world data
The study results show that during the first year after a diagnosis of depressive disorder up to one in six patients have at least two changes in their AD treatment regimen, as indication of treatment resistant depression (TRD)
The resource use, total costs associated with treatment-resistant depression (TRD), mortality and suicidality were higher in TRD patients
Summary
To determine the incidence of Treatment-Resistant Depression (TRD) in Spain and to estimate its economic burden, using real world data. Patients aged ≥18 years with a diagnosis of major depressive-disorder (MDD) who initiated a new antidepressant treatment in 2015–2017 were included. The incidence rate was calculated as the number of TRD patients per 1,000 persons-year divided by the population attended. Two sensitivity analyses were performed varying the index date and the period used to define TRD patients (6 vs. months). The annual population incidence rate of TRD in 2015–2017, was 0.59, 1.02 and 1.18/1,000 personyears, respectively (mean: 0.93/1,000 person-year). Mean total costs per MDD patient were €4,147.9, being higher for TRD than for non-TRD patients (€6,096 vs €3,846; p
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