PMH23 - Predictors of All-Cause Healthcare Payments Among Patients With Treatment-Resistant Major Depressive Disorder

Abstract

Treatment-resistant depression (TRD), defined as episodes of major depressive disorder (MDD) that do not respond to at least 2 lines of adequate depression therapy, is associated with a high economic burden. Limited information exists concerning predictors of healthcare payments following TRD identification. This retrospective cohort study used data from the Truven Health MarketScan Commercial and Medicare Supplemental Databases (10/1/2008-9/30/2016). Patients with TRD were ≥18 years old, newly-diagnosed with MDD (≥1 inpatient admission or ≥2 outpatient visits with a primary or secondary MDD diagnosis), and newly treated with at least 3 courses of depression therapy (initiation of third course served as the TRD index date). Cohort study patients were continuously enrolled from a 12-month baseline period prior to the first course of therapy through a 12-month follow-up period after their TRD index date. Study measures included annual total all-cause healthcare payments (2016 USD) during the follow-up period. Adjusted TRD follow-up payments were estimated using a generalized linear model, controlling for demographics, baseline comorbidities, baseline resource use, and first-line class of therapy. TRD patients (n=1,112) had a mean (SD) age of 38.8 (14.1) and 60.6% were female. Mean (SD) total annual all-cause healthcare payments were $10,161 ($34,275) per patient in the TRD follow-up period, of which 34% ($3,423 [$5,817]) were outpatient payments. In multivariate modeling, younger age (18-24, 25-34, 35-44, 45-54, 55-64 vs. 65+), baseline obesity and pain, higher Charlson comorbidity score (2, 3+ vs. 0), and baseline resource use (ED visit, other visit, outpatient visit) were associated with significant increases in annual all-cause healthcare payments during the follow-up period (all P<.05). Annual all-cause healthcare payments in the 12 months following third-line therapy initiation can be substantial, particularly for younger adult TRD patients with obesity or pain-related diagnoses. Efforts to reduce this economic burden are warranted.