PMH7 ECONOMIC BURDEN OF TREATMENT-RESISTANT DEPRESSION AMONG ADULTS WITH CHRONIC NON-CANCER PAIN CONDITIONS AND MAJOR DEPRESSIVE DISORDER

Abstract

Chronic non-cancer pain conditions (CNPC) and Major Depressive Disorder (MDD) often co-occur and presents a substantial economic burden. Treatment-resistant depression (TRD) in adults with CNPC can amplify the economic burden. This study examined the impact of TRD on total and MDD-related healthcare resource utilization (HRU) and costs among patients with CNPC and MDD. The study used a retrospective longitudinal cohort design and employed a claims-based algorithm to identify adults with TRD from a US claims database (January 2007- June 2017). Costs and HRU were measured over a 12-month period after TRD/non-TRD index date. Counterfactual recycled predictions from generalized linear models were used to examine associations between TRD and annual HRU and costs. Post-regression linear decomposition identified differences in patient-level factors between TRD and non-TRD groups that contributed to the excess economic burden of TRD. Of the 21,180 adults with CNPC and MDD (mean age 55 years, 74% females, 33% had ≥3 CNPC), 10.1% were identified as having TRD. TRD patients had significantly higher HRU, translating into higher average total costs ($21,015TRD vs $14,712No TRD) and MDD-related costs ($1,201TRD vs $471No TRD) compared to non-TRD patients (all P <0.001). Prescription drug costs accounted for 37.6% and inpatient services for 30.7% of the excess total healthcare costs among TRD patients. TRD patients had significantly higher number of inpatient visits (IRR = 1.30, 95% CI = 1.14-1.47) and emergency room visits (IRR = 1.21, 95% CI = 1.10-1.34) than non-TRD patients. Overall, 46% of the excess total costs were explained by differences in patient level characteristics such as polypharmacy, number of CNPC, anxiety, sleep, and substance use disorders between the TRD and non-TRD groups. TRD poses a significant direct economic burden among adults with CNPC and MDD. Excess healthcare costs may potentially be reduced by providing timely interventions for several modifiable risk factors.