Elsevier

Journal of Affective Disorders

Volume 295, 1 December 2021, Pages 578-586
Journal of Affective Disorders

Research paper
Economic impact of treatment-resistant depression: A retrospective observational study

https://doi.org/10.1016/j.jad.2021.08.036Get rights and content
Under a Creative Commons license
open access

Highlights

  • Major depressive disorder it is one of the most common psychiatric diagnoses in the general population.

  • Lack of remission and treatment-resistant depression is associated with a worse quality of life, higher comorbidity, increased resource use, social and occupational disability and worse therapeutic outcomes.

  • The population-based Treatment-Resistant Depression incidence in Spain is 0.93/1000 person-years.

  • Treatment-Resistant Depression is associated with greater resource use and higher costs compared with non-TRD patients.

  • Comorbidity, cumulative mortality and suicide-related behaviors were also significantly higher in Treatment-Resistant Depression patients.

Abstract

Background

To determine the incidence of Treatment-Resistant Depression (TRD) in Spain and to estimate its economic burden, using real world data.

Methods

A retrospective, observational-study was carried out using data from the BIG-PAC database®. Patients aged ≥18 years with a diagnosis of major depressive-disorder (MDD) who initiated a new antidepressant treatment in 2015–2017 were included. The patients were classified as TRD and non-TRD. Patients were classified as TRD if they had, during the first year of antidepressant treatment: a) failure with ≥2 antidepressants including the prescription of ≥3 antidepressants (N06A) or ≥2 antidepressant and ≥1 antipsychotic (N05A; including lithium) b) antidepressants administered for ≥ 4 weeks each, and c) the time between the end of one treatment and the initiation of the next was ≤ 90 days. Inherent limitations of data collection from databases should also be considered in this analysis (e.g., lack of information about adherence to treatment). Follow-up period: 18 months. The incidence rate was calculated as the number of TRD patients per 1,000 persons-year divided by the population attended. Outcomes: direct healthcare and indirect costs. Two sensitivity analyses were performed varying the index date and the period used to define TRD patients (6 vs.12 months).

Results

21,630 patients with MDD aged ≥ 18 years (mean age: 53.2 years; female: 67.2%) were analyzed, of whom 3,559 met TRD criteria, yielding a 3-year cumulative incidence of 16.5% (95%CI: 16%-17%) among MDD patients. The annual population incidence rate of TRD in 2015–2017, was 0.59, 1.02 and 1.18/1,000 person-years, respectively (mean: 0.93/1,000 person-year). Overall, mean total costs per MDD patient were €4,147.9, being higher for TRD than for non-TRD patients (€6,096 vs. €3,846; p<0.001): a) direct costs (€1,341 vs. €624; p<0.001), b) lost productivity (€1,274 vs. €821; p<0.001) and c) permanent disability (€3,481 vs. €2,401; p<0.001, adjusted). Sensitivity analyses showed no differences with the reported results.

Conclusions

The population based TRD incidence in Spain was similar to recent data from other European countries. TRD is associated with greater resource use and higher costs compared with non-TRD patients.

Keywords

Treatment-resistant depression
Major depressive disorder
Incidence
Economic burden

Abbreviation

ANOVA
Analysis of variance
ATC
Anatomical Therapeutic Chemical Classification System
ICD-10-CM
International Classification of Diseases (10th Edition) Clinical Modification
SD
Standard deviation
non-TRD
Non-Treatment Resistant Depression
TRD
Treatment-Resistant Depression
MAS
Mean annual salary
CI
Confidence interval
INE
Spanish National Institute of Statistics
EMR
Electronic medical records
SPSS
Statistical Package for the Social Sciences

Cited by (0)