OBJECTIVES : This study compares differences in economic burden among patients with major depressive disorder (MDD) and patients with treatment-resistant depression (TRD) to the US adult general population.

METHODS : The analysis is based on the US 2017 National Health and Wellness Survey (NHWS). NHWS is a proprietary database of self-reported information that includes socio-demographics and patient-reported validated instruments including the Patient Health Questionaire-9 (PHQ-9), healthcare resource use (HRU), and work productivity loss. The MDD and TRD populations were matched to non-depressed respondents (controls) in the NHWS using propensity score matching controlling for socio-economic, insurance type and general health factors. Estimated direct (from HRU) and indirect costs (from work productivity loss), were compared by MDD, TRD, and controls. Subgroups based on the PHQ-9 scores were examined.

RESULTS : Those with severe depression (PHQ-9 scores of 20-27) had higher direct costs than those who have no or minimal depressive symptoms (PHQ-9 score of 0-4), $28,657 vs. $3,655 per year, p<0.001, respectively. Indirect costs were higher with greater PHQ-9 severity ($4,052 vs. $17,953 per year, p<0.001). Employment rate was 58.4% for those with no/minimal depression and 53.2% for those with severe depression (p<0.001). Direct costs for MDD were higher than matched controls, $6,727 vs. $4,347, p<0.001. Direct costs for TRD were higher than matched controls, $10,756 vs. $4,400, p<0.001. Indirect costs for MDD and matched controls were $10,533 vs. $5,134, p<0.001; and for TRD vs. matched controls, $11,768 vs. $5,466, p<0.001. The employment rates were lower when comparing MDD vs. matched controls (53.4% vs. 58.2%, p<0.001) and TRD vs. matched controls (47.2% vs. 57.1%, p<0.001).

CONCLUSIONS : MDD and TRD were associated with significant burden in terms of direct and indirect costs and impact on employment rates as compared to general population. Findings suggest unmet needs among patients with MDD and TRD and particularly those with severe depression.