A retrospective analysis to estimate the healthcare resource utilization and cost associated with treatment-resistant depression in commercially insured US patients

OBJECTIVE: The economic burden of commercially insured patients in the United States with treatment-resistant depression and patients with non–treatment-resistant major depressive disorder was compared using data from the Optum Clinformatics™ claims database. METHODS: Patients 18–63 years on antidepressant treatment between 1/1/13 and 9/30/13, who had no treatment claims for depression 6 months before the index date (first antidepressant dispensing), and who had a major depressive disorder or depression diagnosis within 30 days of the index date, were included. Treatment-resistant depression was defined as receiving 3 antidepressant regimens during 1 major depressive disorder episode. Patients with treatment-resistant depression were matched with patients with non–treatment-resistant major depressive disorder at a 1:4 ratio using propensity score matching. The study consisted of 1-year baseline (pre-index) and 2-year follow-up (post index) periods. Cost outcomes were compared using a generalized linear model. RESULTS: 2,370 treatment-resistant depression and 9,289 non–treatment-resistant major depressive disorder patients were included. In year 1 of the follow-up period, compared with non–treatment-resistant major depressive disorder, patients with treatment-resistant depression had: more emergency department visits (odds ratio = 1.39, 95% confidence interval = 1.24–1.56); more inpatient hospitalizations (odds ratio = 1.73, 95% confidence interval = 1.46–2.05); longer hospital stays (mean difference vs non–treatment-resistant major depressive disorder = 2.86, 95% confidence interval = 0.86–4.86 days); and more total healthcare costs (mean difference vs non–treatment-resistant major depressive disorder = US$3,846, 95% confidence interval = $2,855-$4,928). These patterns remained consistent in year 2 of the follow-up period. CONCLUSION: Treatment-resistant depression was associated with higher healthcare resource utilization and costs versus non–treatment-resistant major depressive disorder in this commercially insured cohort of patients in the United States.