The Emotional and Financial Burden of Treatment-Resistant Depression


Two studies underscore the importance of appropriate management of depression symptoms from an economic perspective.


Millions of adults live with major depressive disorder (MDD), which has a negative impact on their physical and emotional well-being.

New data presented at this year’s AMCP Nexus and Psych Congress meetings add to the growing body of evidence showing the significant financial burden associated with treatment-resistant depression (TRD) and major depressive disorder (MDD) with suicidal ideation.

Highlights from two separate studies include:

“Incremental Health Care Costs for Persons with Treatment-Resistant Depression in Managed Care Organizations,” a retrospective cohort study used data from the electronic medical records (EMR) and administrative systems of the Kaiser Permanente Northwest (KPNW), included KPNW adult members. The medical and mental healthcare costs of people with TRD were compared to those with MDD and non-MDD controls. The analysis also looked at whether inclusion of clinical symptoms from the nine-item Patient Health Questionnaire (PHQ-9) can refine the understanding of healthcare costs for people with TRD. Groups were evaluated on healthcare costs using generalized linear modeling.

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Findings show the association between the magnitude of depression symptom burden and costs, underscoring the importance of appropriate management of depression symptoms from an economic perspective:

  • Adults with MDD in managed care systems had 82% higher total annual healthcare costs compared to those with no evidence of depression. Those with TRD had 164% higher costs compared to those with no evidence of depression.

  • Among patients with depression, whether MDD or TRD, as symptom burden increased, costs increased as well.

  • Data from the EMR and administrative systems of KPNW were used to analyze the healthcare costs of these three populations.

  • Comparing the cost difference between TRD and MDD patients directly, costs were 45% higher among those with TRD.

“This analysis demonstrates that PHQ-9 data can help refine the understanding of the total cost of TRD,” says John Sheehan, PhD, RPh, director, real-world value and evidence, Janssen Scientific Affairs, LLC. “In general, the costs for persons with TRD who also met the criteria for moderately severe to severe depression by PHQ-9 criteria were significantly higher than the costs for persons with TRD who met the criteria for none to minimal depression by PHQ-9 criteria.”

“Economic Burden of Treatment-Resistant Depression in Privately Insured U.S. Patients with Behavioral Comorbidities” studied adults aged 18 to 65 years with MDD who were identified in the OptumHealth, Inc. database to evaluate the incremental economic burden of TRD in patients with behavioral comorbidities. Patients prescribed a third antidepressant (the index date) after two regimens at adequate dose and duration were defined as having TRD. For non-TRD MDD and non-MDD controls, the index date was randomly selected. 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.

The study took a new step and showed that even in the context of common behavioral health comorbidities, the incremental burden of MDD and TRD persists, highlighting the importance of depression in particular to that burden:

  • This study, presented at Psych Congress in October, focused on the cost burden for adults with TRD who also had a behavioral health comorbidity of anxiety and/or substance use disorders.

  • Using data from the OptumHealth Inc. database, researchers identified the incremental economic burden in adults with private commercial insurance.

  • Adults with MDD plus a behavioral health comorbidity in managed care systems had 69% higher healthcare costs compared with those with no evidence of depression; those with TRD had 157% higher costs compared with those with no evidence of depression.

  • Work-loss related costs were $4,798 among those with no evidence of depression and increased to $7,131 among those with MDD and $13,674 among those with TRD.

“These findings underscore the continued need to find solutions for the millions of adults struggling daily with MDD and TRD,” says Sheehan. “More widespread depression screening and measurement-based care in managed care and other large health systems may help executives and researchers better understand the cost of caring for adults with TRD and evaluate the impact of new solutions on clinical outcomes and cost for those living with severe depression.”

Tracey Walker is senior editor of Managed Healthcare Executive.

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