Economic burden of relapse/recurrence in patients with major depressive disorder

Abstract

Objective: This study was conducted to determine the incremental healthcare resource utilization (HRU) and costs associated with relapse or recurrence (R/R) in patients with major depressive disorder (MDD) treated with antidepressants (AD) in US clinical practice.

Methods: In this retrospective cohort study, adult patients with MDD treated with a branded AD were selected from the Truven Health Analytics MarketScan Databases (January 1, 2004–March 31, 2015). Time to first indicator of R/R was described. Characteristics, HRU, and costs were compared between patients with and without R/R. Among patients with R/R, HRU and costs were also compared between the pre- and post-R/R period.

Results: From the 22,236 selected patients, 5,541 had ≥ 1 indicator of R/R and 16,695 did not. The 3-year R/R rate varied between 21.3% and 36.4% based on pattern of AD use (continuous, switch/augmentation, or early discontinuation). Patients with and without R/R presented different characteristics—notably, more intensive prior AD use and a higher comorbidity burden. HRU and costs were high in both patients with and without R/R but substantially higher among those with R/R ($20,590 vs $12,368 per-patient-per-year (PPPY); adjusted difference [aDiff] = $7,037), mainly driven by increased inpatient (IP) services (adjusted incidence rate ratio IP days = 3.95; aDiff IP costs = $3,433 PPPY). Among patients with R/R, emergency department visits, IP days, and IP admissions were over 2-times higher during the post-R/R period and total costs increased by over 50% from $19,267 to $29,419 in the post-R/R period.

Conclusions: The economic burden in MDD patients is substantial, but is significantly higher among those who experience R/R.

Keywords:

• Major depressive disorder
• relapse/recurrence
• healthcare resource utilization
• costs

Transparency

Declaration of funding

This study was supported by Takeda Pharmaceutical Center USA.

Declaration of financial/other interests

SS and AG are employees of Analysis Group, Inc., which has received consultancy fees from the study sponsor to conduct this study. GG was an employee of Analysis Group, Inc., at the time this study was conducted. LM was an employee of Takeda Pharmaceutical Center USA at the time this study was conducted. JDA peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgements

Medical writing assistance was provided by Cinzia Metallo, an employee of Analysis Group, Inc. Support for this assistance was provided by Takeda Pharmaceutical Center USA.

Data availability statement

The claims database (Truven MarketScan Commercial Database) is proprietary, provided by a third-party vendor, and the authors do not have permission to disseminate the data without the vendor’s approval. The study sponsor has purchased access to the database (the authors have been granted access to the data on a contract per project use). Access to this data set is available to any other interested parties for a fee set by Truven Health Analytics (https://marketscan.truvenhealth.com/marketscanportal/).