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Economic Burden of Treatment-Resistant Depression among Adults with Chronic Non-Cancer Pain Conditions and Major Depressive Disorder in the US

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Abstract

Objective

Major depressive disorder (MDD) and chronic non-cancer pain conditions (CNPC) often co-occur and exacerbate one another. Treatment-resistant depression (TRD) in adults with CNPC can amplify the economic burden. This study examined the impact of TRD on direct total and MDD-related healthcare resource utilization (HRU) and costs among commercially insured patients with CNPC and MDD in the US.

Methods

The retrospective longitudinal cohort study employed a claims-based algorithm to identify adults with TRD from a US claims database (January 2007 to June 2017). Costs (2018 US$) and HRU were compared between patients with and without TRD over a 12-month period after TRD/non-TRD index date. Counterfactual recycled predictions from generalized linear models were used to examine associations between TRD and annual HRU and costs. Post-regression linear decomposition identified differences in patient-level factors between TRD and non-TRD groups that contributed to the excess economic burden of TRD.

Results

Of the 21,180 adults with CNPC and MDD, 10.1% were identified as having TRD. TRD patients had significantly higher HRU, translating into higher average total costs (US$21,015TRD vs US$14,712No TRD) and MDD-related costs (US$1201TRD vs US$471No TRD) compared with non-TRD patients (all p < 0.001). Prescription drug costs accounted for 37.6% and inpatient services for 30.7% of the excess total healthcare costs among TRD patients. TRD patients had a significantly higher number of inpatient (incidence rate ratio [IRR] 1.30, 95% CI 1.14–1.47) and emergency room visits (IRR 1.21, 95% CI 1.10–1.34) than non-TRD patients. Overall, 46% of the excess total costs were explained by differences in patient-level characteristics such as polypharmacy, number of CNPC, anxiety, sleep, and substance use disorders between the TRD and non-TRD groups.

Conclusion

TRD poses a substantial direct economic burden for adults with CNPC and MDD. Excess healthcare costs may potentially be reduced by providing timely interventions for several modifiable risk factors.

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Authors and Affiliations

  1. Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, PO Box 9510, Morgantown, WV, 26506-9510, USA

    Drishti Shah, Suresh S. Madhavan, Wenhui Wei, Traci J. LeMasters & Usha Sambamoorthi

  2. Health Policy, Management, and Leadership Department, School of Public Health, West Virginia University, Morgantown, WV, USA

    Lindsay Allen

  3. Department of Behavioral Medicine and Psychiatry, West Virginia University, Morgantown, WV, USA

    Wanhong Zheng

  4. Department of Pharmacotherapy, College of Pharmacy, University of North Texas Health Sciences Center, Fort Worth, TX, USA

    Suresh S. Madhavan & Usha Sambamoorthi

  5. Regeneron Pharmaceuticals, Tarrytown, NY, USA

    Wenhui Wei

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  1. Drishti Shah
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Correspondence to Drishti Shah.

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Funding

No funding was received for the study. The authors have disclosed that they have no significant relationships with or financial interests in any commercial companies related to this study or article.

Conflict of Interest

Drishti Shah and Suresh Madhavan were employees at West Virginia University at the time of the study. Wenhui Wei is an employee at Regeneron Pharmaceuticals. The authors report no conflict of interest.

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Not applicable.

Availability of Data and Material

This retrospective database study used commercial claims data from the Optum Clinformatics® Data Mart (Eden Prairie, MN, USA). The claims data that support the findings of this study are from a proprietary administrative claims database and are not publicly available. However, summary data tables are available from the authors upon reasonable request.

Code Availability

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Author Contributions

DS was responsible for developing the initial concept and study design. All authors contributed to the subsequent conception, and design of the final study. WZ provided clinical insights, reviewed and approved the clinical algorithms and diagnosis codes used in the current study. DS and US conducted the statistical analyses. The first draft of the manuscript was written by DS. All authors worked on successive iterations, read and approved the final manuscript.

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Shah, D., Allen, L., Zheng, W. et al. Economic Burden of Treatment-Resistant Depression among Adults with Chronic Non-Cancer Pain Conditions and Major Depressive Disorder in the US. PharmacoEconomics 39, 639–651 (2021). https://doi.org/10.1007/s40273-021-01029-2

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