Treatment Failure Event Categories Reveal Progressive Increases in Disease and Economic Burden Among Patients With Major Depressive Disorder
Author(s)
Ling Zhang, MPH, MS, MD1, Carissa S. White Dukes, MPH1, Suzanne St Rose, PhD2, Franco De Crescenzo, PhD2, Anne Kilburg, MSc2, Sigurd Suessmuth, PhD2, Rashmi Patel, PhD, MD3.
1Boehringer Ingelheim, Ridgefield, CT, USA, 2Boehringer Ingelheim, Ingelheim am Rhein, Germany, 3University of Cambridge, Cambridge, United Kingdom.
1Boehringer Ingelheim, Ridgefield, CT, USA, 2Boehringer Ingelheim, Ingelheim am Rhein, Germany, 3University of Cambridge, Cambridge, United Kingdom.
OBJECTIVES: Major depressive disorder (MDD) is characterized by fluctuating episodes of depression and remission. This study constructed disease episodes mirroring the natural course of MDD. Diseases characteristics, healthcare resource utilization (HCRU) and costs at episode level were provided, stratified by different categories of antidepressant treatment failures.
METHODS: Adult MDD patients were identified in US Optum Clinformatics® claims (January 2012 - March 2022). MDD episodes (MEPs) were defined by diagnosis or antidepressant use, allowing a 120-day gap. Treatment failures were defined by three algorithms during active pharmacological treatment period within MEPs: (1) switch/add-on within 1-8 months, (2) any-time switch/add-on, and (3) changes in antidepressants’ generic names. Episodes ≥1 month and within the 99th percentile of cost were included. HCRU and costs were calculated per patient per year (PPPY), stratified by 0, 1, and ≥2 failures.
RESULTS: Among 203,303 patients, 229,602 MEPs were identified with mean duration 15.9 months per episode. Under definition (1), by categories in 0, 1, and ≥2 failures, results showed increasing baseline comorbidities. 54.0%, 52.4%, 47% of episodes started antidepressants intakes on the segment starting date. Emergency room visits occurred in 21.0%, 36.3%, 49.3% and the mean (standard deviation (SD)) of total PPPY costs($) were 22,521 (69,351), 25,274 (57,255), 30,607 (59,526), respectively. Psychotherapy use also increased with failure frequency. Among failures episodes, the mean (SD) of time to failure (in days) is 251.8 (331.3) vs. 218.8 (290.2) in failure 1 vs. ≥2 failures. Consistent trends were observed using definitions (2), (3).
CONCLUSIONS: Higher treatment failure frequency was consistently linked with greater clinical and economic burden, supporting the use as a proxy for disease severity. Meanwhile, different baseline comorbidities profile may influence treatment approaches. Keeping patients on more effective treatment early on could be critical to achieve better long-term outcomes and incur less resource use and associated cost.
METHODS: Adult MDD patients were identified in US Optum Clinformatics® claims (January 2012 - March 2022). MDD episodes (MEPs) were defined by diagnosis or antidepressant use, allowing a 120-day gap. Treatment failures were defined by three algorithms during active pharmacological treatment period within MEPs: (1) switch/add-on within 1-8 months, (2) any-time switch/add-on, and (3) changes in antidepressants’ generic names. Episodes ≥1 month and within the 99th percentile of cost were included. HCRU and costs were calculated per patient per year (PPPY), stratified by 0, 1, and ≥2 failures.
RESULTS: Among 203,303 patients, 229,602 MEPs were identified with mean duration 15.9 months per episode. Under definition (1), by categories in 0, 1, and ≥2 failures, results showed increasing baseline comorbidities. 54.0%, 52.4%, 47% of episodes started antidepressants intakes on the segment starting date. Emergency room visits occurred in 21.0%, 36.3%, 49.3% and the mean (standard deviation (SD)) of total PPPY costs($) were 22,521 (69,351), 25,274 (57,255), 30,607 (59,526), respectively. Psychotherapy use also increased with failure frequency. Among failures episodes, the mean (SD) of time to failure (in days) is 251.8 (331.3) vs. 218.8 (290.2) in failure 1 vs. ≥2 failures. Consistent trends were observed using definitions (2), (3).
CONCLUSIONS: Higher treatment failure frequency was consistently linked with greater clinical and economic burden, supporting the use as a proxy for disease severity. Meanwhile, different baseline comorbidities profile may influence treatment approaches. Keeping patients on more effective treatment early on could be critical to achieve better long-term outcomes and incur less resource use and associated cost.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE734
Topic
Economic Evaluation, Epidemiology & Public Health, Methodological & Statistical Research
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Mental Health (including addition), No Additional Disease & Conditions/Specialized Treatment Areas