Economic Burden of Treatment-Resistant Depression among Adults with Chronic Non-Cancer Pain Conditions and Major Depressive Disorder in the US

• Published in: PharmacoEconomics 2021-06, Vol.39 (6), p.639-651
• Main Authors: Shah, Drishti, Allen, Lindsay, Zheng, Wanhong, Madhavan, Suresh S., Wei, Wenhui, LeMasters, Traci J., Sambamoorthi, Usha
• Format: Article
• Language: English
• Subjects: Algorithms; Antidepressants; Cancer; Care and treatment; Chronic illnesses; Chronic pain; Codes; Complications and side effects; Costs; Drug resistance; Economic aspects; Evaluation; Generalized linear models; Health Administration; Health aspects; Health care expenditures; Health Economics; Major depressive disorder; Medical care, Cost of; Medicine; Medicine & Public Health; Mental depression; Original Research Article; Pain; Patients; Pharmacoeconomics and Health Outcomes; Psychotropic drugs; Public Health; Quality of Life Research; Risk factors
• ISSN: 1170-7690; 1179-2027
• DOI: 10.1007/s40273-021-01029-2

Objective Major depressive disorder (MDD) and chronic non-cancer pain conditions (CNPC) often co-occur and exacerbate one another. Treatment-resistant depression (TRD) in adults with CNPC can amplify the economic burden. This study examined the impact of TRD on direct total and MDD-related healthcare resource utilization (HRU) and costs among commercially insured patients with CNPC and MDD in the US. Methods The retrospective longitudinal cohort study employed a claims-based algorithm to identify adults with TRD from a US claims database (January 2007 to June 2017). Costs (2018 US$) and HRU were compared between patients with and without TRD over a 12-month period after TRD/non-TRD index date. Counterfactual recycled predictions from generalized linear models were used to examine associations between TRD and annual HRU and costs. Post-regression linear decomposition identified differences in patient-level factors between TRD and non-TRD groups that contributed to the excess economic burden of TRD. Results Of the 21,180 adults with CNPC and MDD, 10.1% were identified as having TRD. TRD patients had significantly higher HRU, translating into higher average total costs (US$21,015 TRD vs US$14,712 No TRD ) and MDD-related costs (US$1201 TRD vs US$471 No TRD ) compared with non-TRD patients (all p  < 0.001). Prescription drug costs accounted for 37.6% and inpatient services for 30.7% of the excess total healthcare costs among TRD patients. TRD patients had a significantly higher number of inpatient (incidence rate ratio [IRR] 1.30, 95% CI 1.14–1.47) and emergency room visits (IRR 1.21, 95% CI 1.10–1.34) than non-TRD patients. Overall, 46% of the excess total costs were explained by differences in patient-level characteristics such as polypharmacy, number of CNPC, anxiety, sleep, and substance use disorders between the TRD and non-TRD groups. Conclusion TRD poses a substantial direct economic burden for adults with CNPC and MDD. Excess healthcare costs may potentially be reduced by providing timely interventions for several modifiable risk factors.