OBJECTIVES: To provide a comprehensive evaluation of the economic burden of major depressive disorder (MDD) in the United States (US) in 2019 and estimate the early impact that the COVID-19 pandemic in 2020 may have had on the overall disease burden.

METHODS: A prevalence-based and human capital approach was applied using an estimated annual prevalence of MDD in 2019 proxied from the National Survey on Drug Use and Health (NSDUH) prevalence of those with a major depressive episode in the previous year. Excess costs (2019 US dollars) were evaluated from a societal perspective and included excess healthcare costs and indirect costs (unemployment, absenteeism, presenteeism, disability, mortality, household burden [i.e., impact of living with an adult with MDD on adults without MDD]). The impact of COVID-19 was estimated using NSDUH 2020 estimates.

RESULTS: Using an MDD 2019 prevalence of 7.8%, the number of adults with MDD in the US was estimated at 19.8 million (62.7% female; 37.3% male). The excess economic burden of MDD was estimated at $333.7 billion, or $16,853 per adult with MDD. The primary cost components driving the burden were healthcare costs ($127.3 billion; 38.1%), household burden ($80.1 billion; 24.0%), and presenteeism ($43.3 billion; 13.0%). The majority of the burden (61.9%) was attributed to indirect costs. Lower-bound and upper-bound estimates of the economic burden of MDD were $307.1 and $418.6 billion, respectively. The burden of MDD in 2020 during COVID-19 was estimated to have increased by $47.8 billion (14.3%) compared to 2019, despite using a conservative prevalence estimate (NSDUH, Q1/Q4 2020; MDD prevalence of 8.4%).

CONCLUSIONS: The economic burden of MDD is substantial and goes beyond healthcare costs, underscoring MDD’s impact across multiple aspects of life. The COVID-19 pandemic is estimated to have exacerbated the burden of MDD, highlighting the need to improve MDD management given its large and increasing impact.