OBJECTIVES: To compare the healthcare resource utilization of patients with major depressive disorder with insomnia symptoms (MDD-IS) vs patients with MDD without IS (MDD-nonIS).

METHODS: Patients with a diagnosis of MDD (ICD10 F32*, F33*) and prescriptions for antidepressants were identified from the National Health Insurance Fund (NHIF) database in Hungary. Patients were aged between ≥18 and <65 years. Patients were classified into the MDD-IS group if they had a diagnosis of insomnia (ICD10 G47*, F51*) and/or prescriptions for hypnotics. Patients with MDD with no prescriptions for hypnotics and no diagnosis of insomnia were classified as MDD-nonIS. Patients in the MDD-IS and MDD-nonIS groups were matched using a 1:1 propensity score (PS) matching algorithm based on age, gender, region of residence, and comorbidities. All-cause and MDD-related healthcare resource utilization, such as number of hospitalizations, days in hospital, and number of outpatient visits, were assessed using per patient per year metrics and compared between the MDD-IS and MDD-nonIS groups. The 2‑year survival was also compared.

RESULTS: Of the 332,491 patients with MDD, 18,660 had IS (mean [±SD] age: 49.2 [±11.1] years, 62.3% women). Patients with MDD-IS were well matched to the MDD-nonIS controls (standardized difference <0.1 for all variables included in the PS). More patients with MDD‑IS (vs MDD-nonIS) had hospitalizations (64.5% vs 62.1%), more hospital stays (mean: 3.4 vs 0.9), longer length of stay (mean: 44.4 vs 11.4 days), and on average 1 more outpatient visit per year. The MDD-IS group had significantly higher rates of MDD-related hospitalizations than the MDD-nonIS group (15.3% vs 6.6%). The 2-year survival was significantly worse in patients with MDD-IS vs MDD-nonIS (96% vs 97%; p<0.001).

CONCLUSIONS: In Hungary, patients with MDD-IS incurred significantly higher healthcare resource utilization than those with MDD-nonIS. Further assessment of treatment options for this population is warranted.