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

Figures & data

Table 1. Indicators of R/R.

Indicators of R/R	Patients with R/R, n (%)  (n = 5,541)
Mental health-related ED visit	2,875 (51.9)
Initiation of AD or antipsychotic commonly used for MDD after a treatment interruption of ≥ 6 months	2,515 (45.4)
Psychiatric hospitalization	861 (15.5)
Suicide attempt	416 (7.5)
ECT therapy	185 (3.3)

AD, antidepressant; ECT, electroconvulsive therapy; ED, emergency department; MDD, major depressive disorder; R/R, relapse or recurrence.

Figure 1. Time to first indicator of R/R. R/R, relapse or recurrence.

Table 2. Patient characteristics at baseline.

	R/R cohort (n = 5,541)	R/R-free cohort (n = 16,695)	p-value
Age at index date, mean ± SD [median]	45.4 ± 13.6 [46.0]	45.9 ± 12.9 [47.0]	0.0017*
Female, n (%)	4,002 (72.2)	11,842 (70.9)	0.0652
Region of residence, n (%)
West	2,438 (44.0)	7,543 (45.2)	0.1253
South	1,428 (25.8)	3,847 (23.0)	< 0.0001*
North East	920 (16.6)	3,102 (18.6)	0.0009*
North Central	705 (12.7)	2,039 (12.2)	0.3171
Unknown	50 (0.9)	164 (1.0)	0.5973
Type of healthcare plan, n (%)
PPO	3,414 (61.6)	10,461 (62.7)	0.1636
HMO and POS with capitation	737 (13.3)	2,231 (13.4)	0.9057
POS without capitation and EPO	633 (11.4)	1,676 (10.0)	0.0034*
Comprehensive	365 (6.6)	1,319 (7.9)	0.0014*
CDHP and HDHP	332 (6.0)	754 (4.5)	< 0.0001*
Unknown	60 (1.1)	254 (1.5)	0.0165*
Number of prior generic ADs, mean ± SD [median]	1.2 ± 1.1 [1.0]	1.0 ± 1.0 [1.0]	< 0.0001*
0 generics, n (%)	1,623 (29.3)	6,096 (36.5)	< 0.0001*
Only 1 generic, n (%)	2,051 (37.0)	5,745 (34.4)	0.0004*
2–3 generics, n (%)	1,665 (30.0)	4,505 (27.0)	< 0.0001*
4–5 generics, n (%)	189 (3.4)	335 (2.0)	< 0.0001*
Over 5 generics, n (%)	13 (0.2)	14 (0.1)	0.0052*
Other treatments used, n (%)
Atypical antipsychotics	1,132 (20.4)	2,642 (15.8)	< 0.0001*
Typical antipsychotics	134 (2.4)	239 (1.4)	< 0.0001*
Anxiolytics	2,865 (51.7)	6,684 (40.0)	< 0.0001*
CCI, mean ± SD [median]	0.6 ± 1.2 [0.0]	0.5 ± 1.0 [0.0]	< 0.0001*
Most common comorbidities, n (%)
Anxiety disorders	1,927 (34.8)	4,512 (27.0)	< 0.0001*
Hypertension	1,545 (27.9)	4,005 (24.0)	< 0.0001*
Sleep–wake disorders	1,049 (18.9)	2,644 (15.8)	< 0.0001*
Trauma- and stressor-related disorders	847 (15.3)	2,080 (12.5)	< 0.0001*
Hypothyroidism	779 (14.1)	2,106 (12.6)	0.0056*
All-cause HRU, mean ± SD [median]
IP admissions	0.3 ± 0.8 [0.0]	0.2 ± 0.5 [0.0]	< 0.0001*
IP days	1.3 ± 5.5 [0.0]	0.6 ± 3.9 [0.0]	< 0.0001*
ED visits	1.0 ± 2.2 [0.0]	0.5 ± 1.1 [0.0]	< 0.0001*
Days with OP services	27.1 ± 21.7 [21.0]	22.6 ± 20.1 [17.0]	< 0.0001*

* p < 0.05.

AD, antidepressant; CCI, Charlson Comorbidity Index; CDHP, consumer-driven health plan; EPO, exclusive provider organization; ED, emergency department; HDHP, high-deductible health plan; HMO, health maintenance organization; HRU, healthcare resource utilization; IP, inpatient; OP, outpatient; POS, point of service; PPO, preferred provider organization; R/R, relapse or recurrence; SD, standard deviation.

Figure 2. Average all-cause healthcare costs PPPY: patients with relapse/recurrence vs patients without relapse/recurrence. Models were controlled for the following baseline characteristics: age, sex, region of residence, type of healthcare plan, Charlson Comorbidity Index score, and whether or not patients used atypical antipsychotics, typical antipsychotics, and anxiolytics. aDiff, adjusted difference. ED, emergency department; IP, inpatient; OP, outpatient; PPPY, per-patient-per-year. *p < 0.05.

Figure 3. Average all-cause healthcare costs PPPY: pre-relapse/recurrence vs post-relapse/recurrence period. ED, emergency department; IP, inpatient; OP, outpatient; PPPY, per-patient-per-year. *p < 0.05.

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/).