Medicaid spending burden among beneficiaries with treatment-resistant depression

Pilon, Dominic; Sheehan, John J.; Szukis, Holly; Singer, David; Jacques, Philippe; Lejeune, Dominique; Lefèbvre, Patrick; Greenberg, Paul E.

doi:10.2217/cer-2018-0140

Cited by 20 publications

(30 citation statements)

References 33 publications

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“…In this study, healthcare costs were considerably high and contrary to expectations that IDNs are associated with lower costs [11,15,30]. Instead, the higher HRU and costs among TRD patients relative to non-TRD MDD or non-MDD patients in this study aligned with previous commercial claims-based studies of patients treated in non-IDN settings [6,8,9,31,32]. A recent study, by Amos et al [8], evaluated HRU and costs among commercially insured TRD patients using a similar study design as the present study, which allows for indirect comparisons.…”

Section: Discussionsupporting

confidence: 75%

US Integrated Delivery Networks Perspective on Economic Burden of Patients with Treatment-Resistant Depression: A Retrospective Matched-Cohort Study

Pilon

Szukis

Joshi

et al. 2019

PharmacoEconomics Open

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Objective Our objective was to assess healthcare resource utilization (HRU) and costs among patients with major depressive disorder (MDD) with and without treatment-resistant depression (TRD) and those without MDD in US Integrated Delivery Networks (IDNs). Methods This was a retrospective matched-cohort study. The Optum© Integrated Claims Electronic Health Record deidentified database was used to identify adult patients with TRD (January 2011-June 2017) across US IDNs. TRD patients were propensity score matched 1:1 with non-TRD MDD and non-MDD patients on demographics. Rates of HRU and costs were compared up to 2 years following the first antidepressant pharmacy claim (or randomly imputed date for non-MDD patients) using negative binomial and ordinary least squares regressions, respectively, with 95% confidence intervals (CIs) from nonparametric bootstraps (costs only) adjusted for baseline comorbidity index and costs. Results All 1582 TRD patients were matched to non-TRD MDD and non-MDD patients and evaluated. TRD patients were on average 46 years old, and 67% were female. Mean duration of observation was 20.1, 19.6, and 17.9 months in the TRD, non-TRD MDD, and non-MDD cohorts, respectively. Patients with TRD had significantly higher rates of HRU than did non-TRD MDD patients (inpatient visits 0.35 vs. 0.16 per patient per year [PPPY]; adjusted incidence rate ratio [IRR] 2.04 [95% CI 1.74-2.39]) and non-MDD patients (0.35 vs. 0.09 PPPY, adjusted IRR 3.05 [95% CI 2.54-3.66]). TRD patients incurred significantly higher costs PPPY than did non-TRD MDD patients ($US25,807 vs. 13,701, adjusted cost difference $US9479 [95% CI 7071-11,621]) and non-MDD patients ($US25,807 vs. 8500, adjusted cost difference $US11,433 [95% 876]). Conclusions HRU and costs associated with TRD are significant in US IDNs.Patients with major depressive disorder (MDD) and treatment-resistant depression (TRD) had higher healthcare resource utilization (HRU) and costs than did patients with MDD who were not resistant to treatment and those without MDD in US Integrated Delivery Networks (IDNs).Patients with TRD had longer durations of antidepressant therapies and greater variation in antidepressants; effective treatment strategies are urgently needed for this patient population.

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Section: Discussionsupporting

confidence: 75%

US Integrated Delivery Networks Perspective on Economic Burden of Patients with Treatment-Resistant Depression: A Retrospective Matched-Cohort Study

Pilon

Szukis

Joshi

et al. 2019

PharmacoEconomics Open

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“…Multiple prior studies of treatment-resistant depression have employed a range of criteria to define the treatment-resistant depression patient population. These criteria typically include some combination of the following: clinical diagnosis of depression, number of treatments used (>2 to �4), use of specific medications, time on medication(s), upward titration of medication(s), use of optimization strategies, and results from questionnaires [14][15][16][17][18][19][20][21][22]29]. Therefore, it is not surprising to observe the variance in reported percentages of patients with major depressive disorder who were treatment-resistant, which ranged between 11% and 30%; in most studies, patients with treatment-resistant depression were predominately female (64% to 74%) and between 35 and 55 years of age, although in 1 study [17] only 41% of patients with treatment-resistant depression were female.…”

Section: Discussionmentioning

confidence: 99%

“…The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. [14,20,22]. Among commercially-insured patients, indirect work loss-related costs were also US$1,811 greater in patients with treatment-resistant depression [14].…”

Section: Plos Onementioning

confidence: 99%

“…Greater healthcare utilization and higher healthcare costs have been demonstrated in patients with treatment-resistant depression compared with non-treatment-resistant major depressive disorder [14][15][16][17][18][19][20][21][22]. According to three recent estimates, per-patient per-year direct healthcare costs in patients with treatment-resistant depression versus non-treatment-resistant major depressive disorder were US$6,709 higher among commercially-insured patients,…”

Section: Introductionmentioning

confidence: 99%

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A retrospective analysis to estimate the healthcare resource utilization and cost associated with treatment-resistant depression in commercially insured US patients

Zhang

DiBernardo

et al. 2020

PLoS ONE

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The economic burden of commercially insured patients in the United States with treatmentresistant depression and patients with non-treatment-resistant major depressive disorder was compared using data from the Optum Clinformatics™ claims database. Methods 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. Results 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

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“…Failure of a treatment course was defined as a switch of an AD (no more than 180 days after the end of the previous treatment), the addition of an AD, or the initiation of an augmentation therapy. Initiation of a third AD or augmentation medication defined TRD, consistent with recent literature using insurance claims databases to identify patients with TRD 10,[16][17][18][19][20][21][22] .…”

Section: Study Design Sample Selection and Study Cohortsmentioning

confidence: 62%

Use of home health and other healthcare delivery pathways among privately insured patients with and without treatment-resistant depression

Pilon

Szukis

Singer

et al. 2020

Current Medical Research and Opinion

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Objective: To assess the real-world use of home health services (HHS) among patients with major depressive disorder (MDD) with and without treatment-resistant depression (TRD). Methods: Adults (18-64 years) from a commercial claims database (07/2009 to 03/2015) were categorized into three cohorts: "TRD"(N ¼ 6411), "non-TRD MDD"(N ¼ 33,068), "non-MDD"(N ¼ 149,884) stratified based on use of HHS (HHS vs. no-HHS). Healthcare resource utilization (HRU) and costs were evaluated up to two years following the first antidepressant pharmacy claim using descriptive statistics. HRU (e.g. inpatient, outpatient, emergency department visits) and costs were measured perpatient-per-year (PPPY) in 2015 USD. Results: During the follow-up period, 18.0% of TRD, 12.4% of non-TRD MDD, and 6.5% of non-MDD patients received HHS. Mean all-cause healthcare costs PPPY were numerically higher among patients with HHS use.

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Medicaid spending burden among beneficiaries with treatment-resistant depression

Cited by 20 publications

References 33 publications

US Integrated Delivery Networks Perspective on Economic Burden of Patients with Treatment-Resistant Depression: A Retrospective Matched-Cohort Study

US Integrated Delivery Networks Perspective on Economic Burden of Patients with Treatment-Resistant Depression: A Retrospective Matched-Cohort Study

A retrospective analysis to estimate the healthcare resource utilization and cost associated with treatment-resistant depression in commercially insured US patients

Use of home health and other healthcare delivery pathways among privately insured patients with and without treatment-resistant depression

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