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Abstract

Objective:

This study compared health care use and costs among patients with treatment-resistant versus treatment-responsive depression across Medicaid, Medicare, and commercial payers.

Methods:

A retrospective cohort study was conducted by using Truven Health Analytics’ commercial (2006–2017; N=111,544), Medicaid (2007–2017; N=24,036), and Medicare supplemental (2006–2017; N=8,889) claims databases. Participants were adults with major depressive disorder who had received one or more antidepressant treatments. Treatment resistance was defined as failure of two or more antidepressant treatments of adequate dose and duration. Annual use (hospitalizations and outpatient and emergency department [ED] visits) and costs were compared across patients by treatment-resistant status in each payer population. Incremental burden of treatment-resistant depression was estimated with regression analyses. Monthly changes in costs during 1-year follow-up were assessed to understand differential cost trends by treatment-resistant status.

Results:

In the three payer populations, patients with treatment-resistant depression incurred higher health care utilization than those with treatment-responsive depression (hospitalization, odds ratios [ORs]=1.32–1.76; ED visits, ORs=1.38–1.45; outpatient visits, incident rate ratio=1.29–1.54; p<0.001 for all). Compared with those with treatment-responsive depression, those with treatment resistance incurred higher annual costs (from $4,093 to $8,054 higher; p<0.001). Patients with treatment-resistant depression had higher costs at baseline compared with patients with treatment-responsive depression and incurred higher costs each month throughout follow-up.

Conclusions:

Treatment-resistant depression imposes a significant health care burden on insurers. Treatment-resistant depression may exist and affect health care burden before a patient is identified as having treatment-resistant depression. Findings underscore the need for effective and timely treatment of treatment-resistant depression.

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Information & Authors

Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services
Psychiatric Services
Pages: 593 - 601
PubMed: 32237982

History

Received: 5 August 2019
Revision received: 20 December 2019
Accepted: 10 January 2020
Published online: 2 April 2020
Published in print: June 01, 2020

Keywords

  1. Depression
  2. Economics

Authors

Details

Anshu Shrestha, M.P.H., Ph.D. [email protected]
Public Health Institute, Oakland (Shrestha); Precision Health Economics, Los Angeles (Roach, Everson); TCV, Menlo Park, California (Goutam); Janssen Scientific Affairs, LLC, Titusville, New Jersey (Joshi, Sheehan); Janssen Pharmaceutical Companies of Johnson & Johnson, Titusville, New Jersey (Heerlein); Department of Health Care Policy, Harvard Medical School, Boston (Jena).
Meaghan Roach, M.P.H.
Public Health Institute, Oakland (Shrestha); Precision Health Economics, Los Angeles (Roach, Everson); TCV, Menlo Park, California (Goutam); Janssen Scientific Affairs, LLC, Titusville, New Jersey (Joshi, Sheehan); Janssen Pharmaceutical Companies of Johnson & Johnson, Titusville, New Jersey (Heerlein); Department of Health Care Policy, Harvard Medical School, Boston (Jena).
Kruti Joshi, M.P.H.
Public Health Institute, Oakland (Shrestha); Precision Health Economics, Los Angeles (Roach, Everson); TCV, Menlo Park, California (Goutam); Janssen Scientific Affairs, LLC, Titusville, New Jersey (Joshi, Sheehan); Janssen Pharmaceutical Companies of Johnson & Johnson, Titusville, New Jersey (Heerlein); Department of Health Care Policy, Harvard Medical School, Boston (Jena).
John J. Sheehan, Ph.D., M.B.A.
Public Health Institute, Oakland (Shrestha); Precision Health Economics, Los Angeles (Roach, Everson); TCV, Menlo Park, California (Goutam); Janssen Scientific Affairs, LLC, Titusville, New Jersey (Joshi, Sheehan); Janssen Pharmaceutical Companies of Johnson & Johnson, Titusville, New Jersey (Heerlein); Department of Health Care Policy, Harvard Medical School, Boston (Jena).
Prodyumna Goutam, Ph.D.
Public Health Institute, Oakland (Shrestha); Precision Health Economics, Los Angeles (Roach, Everson); TCV, Menlo Park, California (Goutam); Janssen Scientific Affairs, LLC, Titusville, New Jersey (Joshi, Sheehan); Janssen Pharmaceutical Companies of Johnson & Johnson, Titusville, New Jersey (Heerlein); Department of Health Care Policy, Harvard Medical School, Boston (Jena).
Katie Everson, M.S.
Public Health Institute, Oakland (Shrestha); Precision Health Economics, Los Angeles (Roach, Everson); TCV, Menlo Park, California (Goutam); Janssen Scientific Affairs, LLC, Titusville, New Jersey (Joshi, Sheehan); Janssen Pharmaceutical Companies of Johnson & Johnson, Titusville, New Jersey (Heerlein); Department of Health Care Policy, Harvard Medical School, Boston (Jena).
Kristin Heerlein, M.D.
Public Health Institute, Oakland (Shrestha); Precision Health Economics, Los Angeles (Roach, Everson); TCV, Menlo Park, California (Goutam); Janssen Scientific Affairs, LLC, Titusville, New Jersey (Joshi, Sheehan); Janssen Pharmaceutical Companies of Johnson & Johnson, Titusville, New Jersey (Heerlein); Department of Health Care Policy, Harvard Medical School, Boston (Jena).
Anupam B. Jena, M.D., Ph.D.
Public Health Institute, Oakland (Shrestha); Precision Health Economics, Los Angeles (Roach, Everson); TCV, Menlo Park, California (Goutam); Janssen Scientific Affairs, LLC, Titusville, New Jersey (Joshi, Sheehan); Janssen Pharmaceutical Companies of Johnson & Johnson, Titusville, New Jersey (Heerlein); Department of Health Care Policy, Harvard Medical School, Boston (Jena).

Notes

Send correspondence to Dr. Shrestha ([email protected]).

Competing Interests

At the time this study was conducted, Dr. Shrestha and Dr. Goutam were employees of Precision Health Economics, where Dr. Jena serves as a consultant, which received research funding from Janssen Scientific Affairs. Dr. Jena has received consulting fees unrelated to this work from Amgen, Analysis Group, AstraZeneca, Biogen, Bristol Myers, Celgene, Eli Lilly, Novartis, Pfizer, Sanofi Aventis, Squibb, Tesaro, and Vertex Pharmaceuticals. Ms. Joshi and Dr. Heerlein own stock in Johnson & Johnson. The other authors report no financial relationships with commercial interests.

Funding Information

This study was funded by Janssen Scientific Affairs, LLC.

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