Economic Burden of Treatment Resistant Depression in Privately Insured US Patients With Behavioral Comorbidities

BACKGROUND: Incremental economic burden of treatment resistant depression (TRD) in patients with behavioral comorbidities is largely unknown.

METHODS: Adults < 65 years old with major depressive disorder (MDD) and antidepressant use were identified in the OptumHealth, Inc. database (07/2009-03/2017). Those with a 3rd antidepressant (index date) after 2 regimens at adequate dose and duration were defined as having TRD. For non-TRD MDD and non-MDD controls, index date was randomly selected. Patients with < 6 months of continuous insurance eligibility pre-/post-index, diagnoses of psychosis, schizophrenia, bipolar disorder/mania, dementia, and development disorders, and/or no baseline comorbidities (anxiety and substance use disorders) were excluded. Economic outcomes measuring per-patient-per-year up to 24 months post-index were compared between TRD cohort and control cohorts, matched 1:1 separately.

RESULTS: 3,166 TRD patients (mean age 39 years, 60.5% female) had ≥1 comorbidity (anxiety disorder: 87.3%, substance use disorder: 24.1%). TRD patients had higher healthcare resource use vs non-TRD MDD and non-MDD controls: 0.32 vs 0.20 and 0.14 inpatient admissions, 0.91 vs 0.73 and 0.58 emergency department visits, and 23.8 vs 16.8 and 11.6 outpatient visits, respectively (all p<0.01). TRD patients also had higher healthcare costs ($16,674) vs non-TRD MDD ($10,945) and non-MDD ($6,493) controls (all p<0.01). Among patients with work loss data (N=310 per cohort), TRD patients had more work loss days (54) and higher work loss-related costs ($13,674) vs non-TRD MDD (32 days; $7,131) and non-MDD (17 days; $4,798) controls (all p<0.01).

CONCLUSIONS: In patients with specific behavioral comorbidities, TRD was associated with direct and indirect incremental economic burden.

This poster was presented at the 32nd annual Psych Congress, held Oct. 3-6, 2019, in San Diego, California.