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Abstract
Background: Patients with treatment-resistant depression (TRD) suffer very significant morbidity and are at a disadvantage concerning optimal clinical management. There are high associated societal costs.
Aims: A detailed analysis of health economic costs in the United Kingdom in a group manifesting a severe form of TRD in the 12 months before their participation in a major randomized controlled treatment trial.
Methods: The sample consisted of 118 participants from the Tavistock Adult Depression Study. Recruitment was from primary care on the basis of current major depression disorder of at least 2 years’ duration and two failed treatment attempts. Service utilization was assessed based on self-report and general practitioner (GP) medical records. Generalized linear models were used to identify predictors of cost.
Results: All participants used GP services. Use of other doctors and practice nurses was also high. The mean total societal cost was £22 124, 80% of which was due to lost work and care required of families. Level of general functioning was found to be the most consistent predictor of costs.
Conclusions: Severe forms of TRD are associated with high costs in which unpaid care and lost work predominate. Treatments that improve functioning may reduce the large degree of burden.
Acknowledgements
We would like to acknowledge and thank Hannah Ridsdale, Jenny Hedley, Lauren Whitelaw, Naomi Law, Rebecca Johnson, Siri Steinmo and Zoe Tweedale for data collection and preparation for analysis.
Declaration of interest
No potential conflict of interest was reported by the authors.
This research was funded by the Tavistock Clinic Charitable Foundation and the Tavistock & Portman NHS Foundation Trust. PF is supported by a National Institute for Health Research (NIHR) Senior Investigator Award [grant number NF-SI-0514-10157]. PF was in part supported by the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) North Thames at Barts Health NHS Trust. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.