Total Cost of Care Following First-Line Antidepressant Treatment Failure Among Patients With Major Depressive Disorder in the United States

Abstract: OBJECTIVES: To evaluate total all-cause healthcare costs among US patients diagnosed with major depressive disorder (MDD) who failed first-line antidepressant treatment (ADT). METHODS: Adults (18-64 years) with ≥1 ADT pharmacy claim from 01/01/2018-12/31/2018 (180 days prior to first ADT claim defined as baseline) were identified from a national claims database. Patients with ≥1 MDD ICD-10 code in an inpatient/emergency room setting or ≥2 depression ICD-10 codes as an outpatient (≥1 for MDD), and no prior ADT claim during the baseline period were included. ADT failure was defined as the addition or switch to a non-index ADT within 120 days of first ADT claim (treatment initiation). All-cause costs per patient per month (PPPM) during the time between initiation and index ADT failure, and 90 days post-ADT failure were assessed for both cohorts. RESULTS: Among 29,552 patients with MDD, 7,094 (24%) had first-line ADT failure. Of patients with ADT failure, 62% added and 38% switched ADTs. The PPPM all-cause total healthcare costs during index ADTs were $2,096 and $1,653 respectively for the added-on and switch cohorts. The PPPM all-cause total healthcare costs during the 90 days post-ADT failure were $2,231(+6%) and $1,991(+20%), respectively. CONCLUSIONS: Nearly a quarter of patients with MDD experienced first-line ADT failure. Based on this study observation period, PPPM costs were higher post-ADT failure compared to the cost incurred while patients with MDD were on their index treatment. Further research is needed to optimize treatment strategies in patients with MDD to reduce healthcare costs and improve clinical outcomes.Short Description: We examined total all-cause healthcare costs for US patients with major depressive disorder (MDD) who failed first-line antidepressant treatment (ADT) within 120 days of treatment-initiation, by adding or switching to non-index ADTs. The PPPM costs incurred in the 90 days following ADT-failure were higher than while patients with MDD were on their index treatment. Further research needs to optimize treatment strategies in patients with MDD (stable and unresolved) to reduce healthcare costs and improve outcomes.Name of Sponsoring Organization(s): Sage Therapeutics, Inc., and Biogen Inc.