OBJECTIVES

Treatment-Resistant Depression (TRD), defined as Major Depressive Disorder (MDD) patients who didn’t respond to two successive oral antidepressants of adequate dose/duration. Despite the high level of TRD disease burden, the health care resource utilization (HCRU) and cost of TRD to healthcare systems is unknown. Understanding where intervention is required can inform healthcare systems how to manage patients/resource accordingly, particularly when considering the patient health state. We aimed to quantify monthly HCRU costs of TRD patients, per TRD health states, from the UK healthcare system perspective.

METHODS

A retrospective medical chart review of 295 adult TRD patients in the UK classified as TRD between 1^st Jan 2016 – 31^st May 2016 with data abstracted up to 31^st May 2018 on patient demographics, clinical characteristics, HCRU (primary/secondary care, non-drug and drug interventions for depression, hospitalizations). Costs were split by health states using pooled averages where a state occurred multiple times; Major Depressive Episode (MDE), remission, recovery. MDE costs are the pooled costs collected during the relapse phase and the initial MDE phase. Analyses were descriptive and unit costs derived from the “Unit Costs of Health and Social Care 2017” and British National Formulary. Means [95% CI] are presented for two cost parameters, 1) overall HCRU cost 2) overall HCRU cost minus drug treatment cost.

RESULTS

On average, patients were 43.34 years old, 60% female, 26% in full/part-time employment, 75% had ≥1 comorbidity.

Monthly HCRU costs for MDE were (£991.82 [£775.14, 1208.50]) which reduced at remission (£254.30 [£187.13, 321.46]) and recovery (£98.85 [£65.51, 132.19]).

Monthly HCRU costs, minus drug treatment costs, for MDE were (£980.08 [£761.48, 1198.67]) which reduced at remission (£164.46 [£102.81, 226.11]) and recovery (£83.75 [£47.97, 119.53]).

CONCLUSIONS

These data demonstrate a high monthly cost associated with TRD, especially during MDE health state, highlighting the need for more cost-effective interventions which prevent wider HCRU.