CoChat
Sign Up
Cited by 65Treatment of Major DepressionMental Health Treatment and AccessHealth Systems, Economic Evaluations, Quality of Life

Economic Burden of Treatment-Resistant Depression on the U.S. Health Care System

Open access
Sussman, Matthew, O’sullivan, Amy K., Shah, Ankit, Olfson, Mark, Menzin, Joseph·2019·Journal of Managed Care & Specialty Pharmacy
DOI 10.18553/jmcp.2019.25.7.823PMC PMC10398213
Open this paper in CoChat — free accountOpen PDF

Abstract

BACKGROUND: Treatment-resistant depression (TRD), defined as episodes of depression that do not respond to ≥ 2 lines of adequate depression therapy, is associated with a high economic burden. Although the economic burden of TRD is reported elsewhere, its exact magnitude and current value is uncertain due to differences in methodology in TRD identification. OBJECTIVE: To compare all-cause health care resource utilization (HCRU) and associated health care payments among patients with TRD and those with depression but without TRD, using administrative claims data. METHODS: This retrospective cohort study used data from the Truven Health MarketScan Commercial and Medicare Supplemental Databases (October 1, 2008-September 30, 2016). All patients were aged ≥ 18 years, newly diagnosed with depression (≥ 1 inpatient admission or ≥ 2 outpatient visits with a primary or secondary depression diagnosis), and newly treated with depression therapy. The population included patients with and without TRD. Patients with TRD were defined as having been treated with ≥ 3 courses of depression therapy within a 360-day period (initiation of the third course served as the TRD index date), while patients without TRD (non-TRD) were defined as having been treated with 2 courses of depression therapy. TRD and non-TRD cohorts were matched using propensity scores. Using the TRD index date of their matched TRD pair, non-TRD patients were assigned a simulated index date following second-line therapy. Eligible TRD and non-TRD patients were continuously enrolled from a 12-month baseline period before the first course of therapy through a 12-month follow-up period beginning with the TRD index date and simulated index date, respectively. Annual all-cause HCRU and associated payments (2016 U.S. dollars) were assessed in aggregate and by place of service during the follow-up period and were compared between the matched cohorts using nonparametric Wilcoxon signed-rank tests. RESULTS: The matched analysis included 800 patients in each cohort. For both cohorts, the mean age of patients was 39 years, and 60% were female. All clinical characteristics and all-cause HCRU were comparable at baseline. Compared with non-TRD patients, TRD patients had a significantly higher mean number of all-cause emergency department (ED) visits (0.29 vs. 0.24), outpatient visits (18.0 vs. 13.4), and prescriptions (30.0 vs. 24.0; all P < 0.05) during the 12-month follow-up period. The TRD cohort also had significantly higher mean total all-cause health care payments ($9,890 vs. $6,848; P < 0.001) and mean payments by place of service (ED: $518 vs. $408; outpatient: $3,603 vs. $2,585; pharmacy: $2,613 vs. $1,837; all P < 0.05) compared with the non-TRD cohort. CONCLUSIONS: In relation to propensity score-matched non-TRD patients, TRD patients used significantly more resources (ED visits, outpatient visits, and number of prescriptions) and had significantly higher overall health care payments. These results serve to highlight the unmet need in patients with TRD, suggesting that improved and more effective management of these patients may help reduce the economic burden of disease. DISCLOSURES: This study was funded by Alkermes. Sussman and Menzin, employees of Boston Health Economics, were paid consultants, and Olfson, an employee of Columbia University Irving Medical Center, was an unpaid consultant to Alkermes in connection with the study and development of this research article. O’Sullivan and Shah are employees of the study sponsor. Results from this analysis were first presented at the AMCP Managed Care & Specialty Pharmacy Annual Meeting in Boston, MA, on April 23-26, 2018.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.18553/jmcp.2019.25.7.823

Cites

27 of 27 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • The relatively higher cost of illness attributed to TRD is directly due to higher health care utilization and the need for higher intensity treatments.

    “The relatively higher cost of illness attri­ buted to TRD is directly due to higher health care utilization and the need for higher inten­ sity treatments 20-­ 23 .”

    From Treatment‐resistant depression: definition, prevalence, detection, management, and investigational interventions (2023) · cites this paper as [22]

    The Conclusions (page unavailable) identify differences in payments for emergency department visits, outpatient visits, and prescriptions as significant drivers of TRD’s higher economic burden. The paper does not establish that a need for higher-intensity treatments caused the higher costs, so that causal part of the claim is unsupported. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • A further study of commercially insured patients from a claims database in the US reported that the significant drivers of excess economic burden associated with TRD include healthcare payments related to ED visits, outpatient visits and number of prescriptions.

    “A further study of commercially insured patients from a claims database in the US reported that the significant drivers of excess economic burden associated with TRD include healthcare payments related to ED visits, outpatient visits and number of prescriptions 11 .”

    From A retrospective chart review study to quantify the monthly medical resource use and costs of treating patients with treatment resistant depression in the United Kingdom (2021) · cites this paper as [11]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. Rosenbaum P, Donald R. Reducing bias in observational studies using subclassification on the propensity score. 1984;79(387):516-24.

Cited by

Sorted by citations

Related

Authors
Sussman, M., O’sullivan, A. K., Shah, A., Olfson, M., & Menzin, J.
Affiliations
  • Boston Health Economics, Boston, Massachusetts.
  • Alkermes (United States) (US)
  • Columbia University Irving Medical Center (US)
ORCID
Venue
Journal of Managed Care & Specialty Pharmacy
Publisher
Academy of Managed Care Pharmacy
Published
2019-07
Volume
25
Issue
7
Pages
823-835
ISSN
  • 2376-0540 (ISSN-L)
  • 2376-1032
DOI
10.18553/jmcp.2019.25.7.823
PMC
PMC10398213
OpenAlex
W2952578240
Cited by
65
References
27
Citations by year
2026: 3 · 2025: 14 · 2024: 7 · 2023: 12 · 2022: 9 · 2021: 13 · 2020: 6 · 2019: 1
FWCI
4.49
Type
journal article
Language
en
Open access
Locations
  • Journal of Managed Care & Specialty Pharmacy (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
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, economic burden, healthcare resource utilization, health care payment, emergency department visits, outpatient visits, prescription drug use, hospitalization, depression treatment, Medicare Supplemental, private insurance
MeSH terms
Adult, Antidepressive Agents, Delivery of Health Care, Female, Medicare, Humans, Male, Middle Aged, Patient Acceptance of Health Care, Retrospective Studies, United States, Cohort Studies, Health Care Costs, Cost of Illness, Young Adult, Depressive Disorder, Treatment-Resistant

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review