Health Care Burden for Patients With Treatment-Resistant Depression Similar Among Multiple Payer Types

During a session held at the ISPOR annual meeting, Jack Sheehan, PhD, MBA, discussed health care utilization and associated costs among patients with treatment-resistant depression (TRD) who are covered by commercial health plans, Medicaid, and Medicare. 

At the start of the session Dr Sheehan explained to the audience that Agency for Healthcare Research and Quality defines TRD as “a continuing depressive episode following at least two prior antidepressants treatment of at least 4 or 6 weeks of an adequate dose.” 

He explained that TRD affects roughly 20 to 30% of patients who experience a major depressive disorder (MDD). Dr Sheehan told the audience that previous study findings have shown that patients with TRD incur a significantly higher health care burden compared with patients without a MDD. 

According to Dr Sheehan, past studies have shown that “privately insured TRD patients have 40 to 49% higher health care costs than their match non-TRD MDD controls.” 

“However, such studies have been restricted to a single-payer population,” he noted. In order to address knowledge gaps that exist regarding health care costs among patients with TRD, Dr Sheehan and his colleagues assessed “incremental annual health care resource utilization and associated costs among patients with TRD MDD, compared to non-TRD MDD patients in national US health plans, including commercial, Medicaid, and Medicare as well as to assess health care cost trends over 12-months period.” 

He said that his team hoped to compute total annual all-cause and mental health-related health care utilization for outpatient visits, hospitalizations, and emergency department (ED) visits, as well as annual health care costs. 

Dr Sheehan told the conference attendees that the study took place from January 2006 through October 2017. He said they used Truven Health Analytics Commercial, Medicaid, and Medicare Supplemental databases. They began examining Commercial and Medicare Supplemental in January 2006, and Medicaid in January 2007. The researchers examined all 3 types through October 2017. The patients included in the study were 18 years or older and were diagnosed with MDD and treated with at least one anti-depressant (AD) drug. The research team included all TRD patients and 15% simple random sample of non-TRD patients. Finally, Dr Sheehan said that “each patient was identified as having either TRD or non-TRD MDD based on prescription patters observed on claims data.” 

Once the patient population was identified, Dr Sheehan said that he and his colleagues took an analytic approach to assess the data. They used a descriptive analysis to assess the comparability of the TRD and non-TRD group at baseline. A multivariable regression analyses that was adjusted for baseline covariates to assess associations between TRD status and outcomes of interest. Finally, they used a time trend analysis of monthly health care costs during a 12-month follow-up period based on visual assessment. The time trend analysis was used to “compare patterns of total all-cause and mental-health related health care costs across the two [study] groups over time, separated by payer type.” 

According to the findings, patients with TRD had “32% to 76% more odds of hospitalization, 38%-45% more odds of ED visits, and 1.29 to 1.54 times higher rates of outpatient visits compared with non-TRD MDD across all three databases.” Additional findings show that patients with TRD “incurred approximately $4,093-$8,054 higher annual treatment costs compared to non-TRD MDD.” 

“Consistently higher health care utilization and costs were observed among TRD patients compared with non-TRD MDD patients. This was observed across all three payer types,” Dr Sheehan told the audience. 

“Higher treatment costs among TRD patients were observed from the start of the follow-up period, with smaller decline over time compared to non-TRD MDD patients, suggesting that TRD may be a disease state that exists early on and impacts health care utilization even before the patients are identified as such based on their treatment failure.” 

At the conclusion of his presentation, Dr Sheehan explained to the audience that the findings of this study highlight the need for innovative and effective treatments. He also said that the findings demonstrate an opportunity for earlier diagnostics for TRD patients. —Julie Gould