OBJECTIVES: Treatment-resistant depression (TRD) affects an estimated 20-30% of patients with Major Depressive Disorder (MDD) and represents a critical unmet need in the management of the disease. This study compared the healthcare burden of patients with TRD versus non-TRD MDD covered by Commercial, Medicaid, and Medicare health plans.

METHODS: This retrospective longitudinal study used Truven Health Analytics’ Commercial (2006-2016), Medicaid (2007-2015), and Medicare Supplemental (2006-2016) claims databases. Each sample included adults (age ≥18) with MDD, who had received ≥1 antidepressant treatment. Patients with TRD were defined as those who failed ≥2 antidepressants of adequate dose and duration. Within each sample, 15% of the remaining patients were randomly selected to represent the patients with non-TRD MDD. Annual healthcare utilization (hospitalization, outpatient and emergency department/ED visits) and costs were compared across patients with TRD and non-TRD MDD in each of the three cohorts. Logistic, linear, or negative binomial regressions were used to estimate the incremental burden of TRD during the 12-month period immediately following the date of antidepressant treatment initiation (index date), adjusted for demographic and baseline characteristics assessed during 6-month pre-index period.

RESULTS: A total of 27,595, 5,556, and 1,856 patients with TRD and 83,949, 18,480, and 7,033 non-TRD MDD in Commercial, Medicaid, and Medicare health plans were analyzed, respectively. TRD was associated with higher healthcare utilization and costs versus non-TRD MDD in all three samples assessed. Patients with TRD had 32%-76% more odds of hospitalization, 38%-45% more odds of ED visits, and 1.29-1.54 times higher rates of outpatient visits compared to non-TRD MDD across all three databases (all p<0.0001). Further, patients with TRD incurred approximately $4,093-$8,054 higher annual treatment costs compared to non-TRD MDD (p<0.0001).

CONCLUSIONS: Patients with TRD consistently incur higher healthcare burden across health plans. These findings highlight the need for more effective treatments to manage TRD burden.