Economic burden of treatment-resistant depression among veterans in the United States

Abstract

Objective: Evidence is limited on the economic burden associated with treatment-resistant depression (TRD) among US veterans. We evaluated the economic burden among patients with major depressive disorder (MDD) with and without TRD, and those without MDD in the Veterans Health Administration (VHA).Methods: Three cohorts were identified using VHA claims data (01APR2014-31MAR2018).Patients with MDD (aged ≥18) who failed ≥2 antidepressant treatments of adequate dose and duration were defined as having TRD; patients with MDD not meeting this criterion constituted the non-TRD MDD cohort (index: first antidepressant claim). The non-MDD cohort included those without MDD diagnosis (index: randomly assigned). Patients with psychosis, schizophrenia, manic/bipolar disorder, or dementia in the 6-month pre-index period were excluded. Patients with non-TRD MDD and non-MDD were matched 1:1 to patients with TRD based on demographic characteristics (age, gender, race, index year). Health care resource utilization (HRU) and costs were analyzed during the post-index period using a negative binomial model and ordinary least squares regression model, respectively.Results: After 1:1 exact matching, 10,449 patients were included in each cohort (mean age: 48.9 years). Patients with TRD had higher per patient per year (PPPY) HRU than non-TRD MDD (all-cause inpatient visits: incidence rate ratio [IRR]: 1.70 [95% confidence interval: 1.57-1.83])

Genetic Correlates of Treatment-Resistant Depression: Insights from Polygenic Scores Across Cognitive, Temperamental, and Sleep Traits in the All of US cohort

“…Out of 8.9 million treated MDD patients in the US, about 2.8 million are estimated to have TRD, which amounts to an overall cost of almost $44 billion in treating these patients 4 . Compared to treatment responsive individuals, those with TRD are 20% 5 to 30% 6 more expensive to treat, account for as much as 70% 7 more emergency department visits, outpatient visits, and prescriptions 8 , and are 40% more likely to be hospitalized 9 . These individuals have greater lost productivity 10 , higher rates of permanent disability 11 , and higher levels of suicide attempts and completed suicide 12 .…”

The prevalence and economic burden of treatment-resistant depression in Thailand

“…This evaluation encompassed tangible costs, such as healthcare expenditures and medication costs, and expenses associated with commuting to healthcare facilities, as well as intangible costs, including productivity loss and work absenteeism. Previous literature found that the economic burden of TRD was significantly higher than that of non-TRD [ 11 , 22 – 25 ]. The annual incremental burden of TRD in the United States was approximately $43.8 billion.…”

The Prevalence and Economic Burden of Treatment-Resistant Depression in Thailand

“…This included tangible and intangible costs of TRD, such as productivity loss, work loss, and cost of commuting to the hospital. Previous literature found that the economic burden of TRD was signi cantly higher than that of non-TRD depressive disorders (Gibson et al, 2010;Olchanski et al, 2013;Pérez-Sola et al, 2021;Shah et al, 2021;Szukis et al, 2021). The national economic burden of TRD in the USA was estimated to cost 43.8 billion dollars annually, of which 47.2% account for the burden of MDD medications (Zhdanava et al, 2021).…”