OBJECTIVES

: To evaluate the economic and clinical burden of treatment-resistant depression (TRD) across the countries under Gulf Cooperation Council - the Kingdom of Saudi Arabia (KSA), Kuwait, and the United Arab Emirates (UAE) from a payer’s perspective.

METHODS

: A Microsoft Excel^® based Markov model was developed to assess overall burden of TRD among adults with major depressive disorder (MDD). Assessments were based on the treatment pathway for TRD patients and their health-states in response to treatment . Data for the model adaptation were retrieved from literature and validated by country-specific key opinion leaders. The cycle-length and time-horizon used in the model were 4 weeks and 1-year, respectively. Key model inputs included MDD prevalence, number of patients who progressed to TRD and cost components which included both direct and indirect costs.

RESULTS

: At the end of 1-year time-horizon, total number of TRD patients were estimated to be 101,639 in the KSA, 13,549 in Kuwait, and 32,412 in the UAE. The overall estimated economic burden imposed by these patients was Saudi Riyal (SAR) 14,997 million in the KSA, Kuwaiti Dinar (KWD) 304 million in Kuwait, and UAE Dirham (AED) 2,461 million in the UAE. The major contributing factor towards this burden based on the health states was incurred by non-responsive state accounting for 43.6%-47.4% of the overall estimate in these countries. By intervention, cost incurred by electroconvulsive therapy integration was considered as major contributor (ranging from 75.2%-88.2%). Of all cost components, indirect-cost associated with productivity loss was either the highest or second-highest contributor to the overall burden (ranging from 31.5%-42.9%).

CONCLUSIONS

: TRD poses a huge clinical and economic burden on the healthcare system in the KSA, Kuwait, and the UAE. Increased levels of treatment-resistance and resource demanding aggressive interventions necessitate the introduction of innovative treatment modalities to improve TRD management.