Treatment-Resistant Depression Consumes Billions of Dollars

On average, the annual direct (health care) and indirect (productivity) costs for an individual with treatment-resistant depression were nearly double those of someone with treatment-responsive depression and nearly quadruple the annual health care costs for the general population ($20,120 vs. $10,592 vs. $5,095).

The authors noted that the study did not factor in the burdens of depression on friends, family, and caregivers, which likely raises the societal costs even more than the costs identified in this study, but not enough published data exist to factor those variables into the cost equation.

“Our study highlights how treatment-resistant depression creates a huge wake,” said Hornberger. “Perhaps more than any other disease, a mental health disorder disrupts every aspect of a person’s life and permeates every level of society, including medical care resources, school and work safety, employment opportunities and related work losses, and, not least, effects on family members.”

Jerry Halverson, M.D., medical director of adult services at Wisconsin’s Rogers Memorial Hospital–Oconomowoc and a member of APA’s Council on Advocacy and Government Relations, was not surprised by the results. “The findings perfectly underline what we as clinicians see every day,” he said in an interview. “Our patients have many physical and psychiatric comorbidities in addition to the depression, so they not only account for a proportionally higher percent of the health care spending, but their quality of life is often terrible—it makes everyday life for them that much more difficult.”

Though the review focused on the big picture, Halverson noted that even small changes in clinician practices could be instrumental in helping lower the cost burden. “Psychiatrists can exert some control over the flow of costs in mental health through the treatments that they recommend, as I have seen through some claims-based modeling we are doing in Wisconsin. If psychiatrists prescribed generics just 10 percent more often, for example, that could save a great deal of money, which could then be spent on other programs that support our patients including social services.”

Improved efficiency and access will be needed, but resources are necessary too, Hornberger believes. “Yes, there are many generic drugs at our disposal, but the flip side of that coin is the declining rate of new drug development,” he said. “Innovation is still needed to solve the problem of this societal burden. That requires funding for basic research, clinical research, and translational research that leads to changes in clinical policy and effects meaningful changes in outcomes and costs.”

The disparity in costs versus NIH funding for depression research highlights the uphill battle facing mental health care, but Hornberger noted that a focus on lost productivity could bring more attention to depression’s huge influence. Compared with heart disease or cancer, for example, mental disorders have a lower average age of onset and thus are heavily prevalent among the workforce—disability or absenteeism alone contributed $6,924 in costs annually for each case of treatment-resistant depression, the review found.

This study was supported by Assurex Health through a research contract with Cedar Associates. ■