OBJECTIVES: This study assessed healthcare resource utilization (HRU) and costs of patients with major depressive disorder (MDD) and acute suicidal ideation or behavior (MDSI) compared to MDD without suicidal ideation (MDD) and without MDD (non-MDD).

METHODS: Adults were identified in the MarketScan® Databases (10/2015-02/2020). The MDSI cohort received an MDD diagnosis on the same day or within 6 months before a claim for acute suicidal ideation or behavior (index date). Index date was a random date with an MDD claim in the MDD cohort, and a random date in the non-MDD cohort. All patients had continuous eligibility ≥12 months pre- and ≥1 month post-index. HRU and costs (2020 US$) were compared during 1- and 12-month post-index periods between the MDSI and control cohorts matched 1:1.

RESULTS: The MDSI cohort included 73,242 patients (mean age 35 years, 60.6% female, 37.2% Medicaid coverage) matched to controls in each cohort. During 1 month post-index, the MDSI cohort had 12.8 times more inpatient admissions and 3.3 times more emergency room (ER) visits versus the MDD cohort, as well as 67.2 times more inpatient admissions, 8.9 times more ER visits, and 2.9 times more outpatient visits versus the non-MDD cohort (all p<0.001). During 12 months post-index, HRU remained higher in the MDSI versus control cohorts. During 1 and 12 months post-index, respectively, the MDSI cohort had higher mean healthcare costs per-patient-month ($7,272 and $2,068) vs the MDD ($2,017 and $1,122) and non-MDD ($598 and $696) cohorts (all p<0.001). During 1 and 12 months post-index, inpatient costs drove 89.5% and 77.8% of cost differences versus the MDD cohort, and 81.1% and 63.6% versus the non-MDD cohort, respectively.

CONCLUSIONS: MDSI is associated with substantial economic burden driven by inpatient costs. The economic burden of MDSI is concentrated in the first month post-index, persisting during the following year.