REAL-WORLD CHARACTERISTICS AND ADVANCED THERAPY USE IN U.S. PATIENTS WITH MODERATE-SEVERE TREATMENT RESISTANT DEPRESSION (TRD)
Author(s)
irene cosmatos, MSc1, Judith Maria Lytle, PhD MBEE PMP2, Dawn Albright, MS3, Samuel Igweokpala, MSc4.
1United Biosource, LLC, King of Prussia, PA, USA, 2UBC, Seattle, WA, USA, 3UBC, King of Prussia, PA, USA, 4United BioSource LLC (UBC), King of Prussia, PA, USA.
1United Biosource, LLC, King of Prussia, PA, USA, 2UBC, Seattle, WA, USA, 3UBC, King of Prussia, PA, USA, 4United BioSource LLC (UBC), King of Prussia, PA, USA.
OBJECTIVES: Treatment-resistant depression (TRD) is a common and debilitating form of major depressive disorder (MDD) in which current pharmacologic and psychotherapeutic strategies often provide only partial or short-term benefits. This retrospective cohort study used a large U.S. claims database to describe real-world characteristics of MDD patients receiving advanced therapies for moderate-severe TRD, including neurostimulation techniques (NT) therapies such as transcranial magnetic stimulation (TMS) and electroconvulsive therapy (ECT), as well as specialized pharmacotherapies like glutamatergic modulators (e.g., esketamine).
METHODS: Adult MDD patients with claims for TMS, ECT and/or a glutamatergic modulator (index date) in Komodo’s Healthcare Map® between March 2019 - March 2024 were identified as the advanced TRD therapy cohort. Advanced therapy utilization was described over 2 years of post-index follow-up. Demographics, payer distribution, and the use of traditional antidepressants during follow-up as well as a 6-month baseline period were also assessed.
RESULTS: Amongst the advanced therapy cohort (N= 274,353), 65.1% were female and the majority (63.9%) were 45 years and older. Overall, 54.4% had ≥1 NT claim (TMS:70.3%; ECT:32.4%), and 44.4% received specialized pharmacotherapy during follow-up. Across all therapies, utilization declined after therapy initiation, most notably in patients initiating TMS, where use decreased by more than 70% within the first 6 months and remained low throughout follow-up. Nearly half of patients (48.3%) had commercial insurance. The remainder were covered mostly by public insurance: Medicare (31.7%) or Medicaid (19.1%). During baseline, the most common traditional antidepressants were duloxetine (34.7%), sertraline (30.2%), escitalopram (29.9%), and fluoxetine (27.9%). This pattern remained fairly constant after advanced therapy initiation, especially during the first year of follow-up.
CONCLUSIONS: This study highlights that advanced therapies are used in real-world settings to initially manage moderate-severe TRD, with reimbursement provided by commercial and government insurers. Future studies need to investigate challenges in sustaining advanced treatment to improve real‑world care pathways in TRD.
METHODS: Adult MDD patients with claims for TMS, ECT and/or a glutamatergic modulator (index date) in Komodo’s Healthcare Map® between March 2019 - March 2024 were identified as the advanced TRD therapy cohort. Advanced therapy utilization was described over 2 years of post-index follow-up. Demographics, payer distribution, and the use of traditional antidepressants during follow-up as well as a 6-month baseline period were also assessed.
RESULTS: Amongst the advanced therapy cohort (N= 274,353), 65.1% were female and the majority (63.9%) were 45 years and older. Overall, 54.4% had ≥1 NT claim (TMS:70.3%; ECT:32.4%), and 44.4% received specialized pharmacotherapy during follow-up. Across all therapies, utilization declined after therapy initiation, most notably in patients initiating TMS, where use decreased by more than 70% within the first 6 months and remained low throughout follow-up. Nearly half of patients (48.3%) had commercial insurance. The remainder were covered mostly by public insurance: Medicare (31.7%) or Medicaid (19.1%). During baseline, the most common traditional antidepressants were duloxetine (34.7%), sertraline (30.2%), escitalopram (29.9%), and fluoxetine (27.9%). This pattern remained fairly constant after advanced therapy initiation, especially during the first year of follow-up.
CONCLUSIONS: This study highlights that advanced therapies are used in real-world settings to initially manage moderate-severe TRD, with reimbursement provided by commercial and government insurers. Future studies need to investigate challenges in sustaining advanced treatment to improve real‑world care pathways in TRD.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EPH229
Topic
Epidemiology & Public Health, Health Service Delivery & Process of Care, Real World Data & Information Systems
Disease
Mental Health (including addiction)