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Cited by 48Treatment of Major DepressionMental Health Treatment and AccessHealth Systems, Economic Evaluations, Quality of Life

Prospective Service Use and Health Care Costs of Medicaid Beneficiaries with Treatment-Resistant Depression

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Olfson, Mark, Amos, Tony B., Benson, Carmela, McRae, Jacquelyn, Marcus, Steven C.·2018·Journal of Managed Care & Specialty Pharmacy
DOI 10.18553/jmcp.2018.24.3.226PMC PMC10398231
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Abstract

BACKGROUND: Although the clinical and health economic characteristics of commercially insured adults with treatment-resistant depression (TRD) have been well characterized, little is known about TRD in the Medicaid population. OBJECTIVE: To describe clinical and health economic characteristics of adult Medicaid beneficiaries with TRD. METHODS: Retrospective longitudinal cohort analyses were performed with Truven Health MarketScan Medicaid Database (2008-2014), focusing on adults with major depressive disorder (MDD) following an index antidepressant prescription. TRD was operationally defined as starting a third treatment regimen after 2 adequate regimens of antidepressants or augmentation therapy within 12 months of an index antidepressant prescription. Among patients with and without TRD, percentages with inpatient admissions, emergency department visits, and outpatient visits (all cause, mental health related, and depression related) were determined. Logistic regression models were used to examine associations between TRD status and use of inpatient, outpatient, and emergency services. Separate analyses were performed for the first and second year after the index antidepressant prescription. RESULTS: Approximately one quarter (25.9%) of pharmacologically treated adults with MDD met criteria for TRD. In relation to MDD patients without TRD, patients with TRD were proportionately more likely to be older, male, and white. Compared with MDD patients without TRD, patients with TRD were also significantly more likely to receive inpatient care for any cause (31.0% vs. 21.6%; P < 0.001), a mental health-related reason (12.7% vs. 7.6%; P < 0.001), or depression (10.1% vs. 6.1%; P < 0.001) during the first year following their index antidepressant prescription. Over the second follow-up year, patients with TRD continued to be more likely than patients without TRD to receive inpatient care for any reason (26.7% vs. 19.5%; P < 0.001), a mental health-related reason (5.6% vs. 2.7%; P < 0.001), and depression (3.7% vs. 1.7%; P < 0.001). The mean health care costs of patients with TRD were also significantly higher than the costs of patients without TRD during the first year ($18,982 [SD ± $35,276] vs. $11,642 [SD ± $29,203]) and second year ($17,997 [SD ± $34,146] vs. $10,325 [SD ± $28,224]) following the index antidepressant prescription. CONCLUSIONS: In the U.S. Medicaid program, adults with TRD have substantially and persistently higher health care costs than their counterparts who do not meet criteria for TRD. The service use and health care cost patterns of patients with TRD in the Medicaid program highlight challenges of developing interventions and care coordination strategies to meet their complex clinical needs. DISCLOSURES: This project was sponsored by Janssen Scientific Affairs. Olfson received a grant from Janssen Scientific Affairs through Columbia University Medical Center. Amos and Benson are employees of Janssen Scientific Affairs. Marcus was paid by Janssen Scientific Affairs to provide consulting support for this study and reports fees from Sunovion Pharmaceuticals and Alkermes outside of this study. McRae was a fellow affiliated with Janssen Scientific Affairs during the development of this research and manuscript. Study concept and design were contributed by Amos, Olfson, Marcus, Benson, and McRae. Data analysis was performed by all the authors. The manuscript was primarily written by Olfson, along with the other authors, and revised by McRae, Benson, Amos, Marcus, and Olfson. A different data cut from the same database was presented previously at the 2017 Annual Meeting of the International Society for Pharmacoeconomics and Outcomes Research; May 20-24, 2017; Boston, MA; and the 2017 AcademyHealth Annual Research Meeting; June 25-27, 2017; New Orleans, LA.

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  • Higher indirect costs are reported in TRD as a consequence of relatively greater impairment in psychosocial function, greater need for disability benefits, higher workplace disability and absenteeism, as well as negative impact on carers.

    “Higher indirect costs are also reported in TRD as a consequence of rel­ atively greater impairment in psychoso­ cial function, greater need for disability benefits, higher workplace disability and absentee­ ism, as well as the negative impact on carers 10, 21,24-­ 35 .”

    From Treatment‐resistant depression: definition, prevalence, detection, management, and investigational interventions (2023) · cites this paper as [29]

    The Discussion reports higher health care costs for Medicaid beneficiaries with TRD, and the Independent and Dependent Variables section identifies the measured costs as direct costs. Our copy does not report higher indirect costs or link them to disability benefits, workplace disability, absenteeism, psychosocial impairment, or effects on carers (searched: indirect costs, absenteeism, disability). (LLM, conf=0.76)

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Authors
Olfson, M., Amos, T. B., Benson, C., McRae, J., & Marcus, S. C.
Affiliations
  • New York State Psychiatric Institute (US)
  • Janssen Scientific Affairs (United States) (US)
  • University of Pennsylvania (US)
ORCID
Venue
Journal of Managed Care & Specialty Pharmacy
Publisher
Academy of Managed Care Pharmacy
Published
2018-03
Volume
24
Issue
3
Pages
226-236
ISSN
  • 2376-0540 (ISSN-L)
  • 2376-1032
DOI
10.18553/jmcp.2018.24.3.226
PMC
PMC10398231
OpenAlex
W2787885435
Cited by
48
References
39
Citations by year
2025: 4 · 2024: 7 · 2023: 5 · 2022: 7 · 2021: 6 · 2020: 8 · 2019: 9 · 2018: 2
FWCI
4.03
Type
journal article
Language
en
Open access
Locations
  • Journal of Managed Care & Specialty Pharmacy (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
Janssen Scientific Affairs
Topics
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
Keywords
treatment-resistant depression, major depressive disorder, Medicaid beneficiaries, health care costs, health care utilization, hospitalization, emergency department visits, outpatient visits, antidepressant treatment, mental health services, health disparities, health insurance coverage, quality of care
MeSH terms
Adolescent, Adult, Antidepressive Agents, Female, Follow-Up Studies, Humans, Longitudinal Studies, Male, Medicaid, Middle Aged, Patient Acceptance of Health Care, Prospective Studies, Retrospective Studies, United States, Cohort Studies, Health Care Costs, Young Adult, Depressive Disorder, Treatment-Resistant

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