Economic Implications of Treatment-Resistant Depression Among Employees
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Background: Conservative estimates indicate between 10% and 20% of all individuals with major depressive disorders (MDDs) fail to respond to conventional antidepressant therapies. Amongst those with MDD, individuals with treatment-resistant depression (TRD) have been found to be frequent users of healthcare services and to incur significantly greater costs than those without TRD. Given the prevalence of the disorder, it is understandable that MDDs are responsible for a significant amount of both direct and indirect healthcare costs.
Objective: To provide empirical findings for employees likely to have TRD based on analysis of employer claims data, in the context of previous research.
Methods: We conducted a claims data analysis of employees of a large national (US) employer. The data source consisted of medical, pharmaceutical and disability claims from a Fortune 100 manufacturer for the years 1996–1998 (total beneficiaries <100 000). The employee sample included individuals with medical or disability claims for MDDs (n = 1692). A treatment pattern algorithm was applied to classify MDD patients into TRD-likely (n = 180) and TRD-unlikely groups. Treated prevalence of select comorbid conditions and the patient costs (direct and indirect) from the employer perspective by condition were compared among TRD-likely and TRD-unlikely employees, and with a 10% random sample of the overall employee population for 1998.
Results: The average annual cost of employees considered TRD-likely was $US14 490 per employee, while the cost for depressed but TRD-unlikely employees was $US6665 per employee, and $US4043 for the employee from the random sample. TRD beneficiaries used more than twice as many medical services compared with TRD-unlikely patients, and incurred significantly greater work loss costs.
Conclusion: TRD has gained increasing recognition due to both the clinical challenges and economic burdens associated with the condition. TRD imposes a significant economic burden on an employer. TRD-likely employees are more likely to be treated for selected comorbid conditions and have higher medical and work loss costs across all conditions.
KeywordsMajor Depressive Disorder Major Depressive Disorder Claim Data Major Depressive Disorder Patient Medical Claim
Unconditional financial support provided by Eli Lilly and Company. Patricia K. Corey-Lisle and Ami Claxton were employees of Eli Lilly and Company at the time this manuscript was written.
- 3.American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association, 1994Google Scholar
- 5.American Psychiatric Association. Practice guidelines for the treatment of patients with major depressive disorder (revision). Am J Psychiatry 2000; 157 (4): 1–45Google Scholar
- 8.Thompson D, Buesching D, Gregor KJ, et al. Patterns of antidepressant use and their relationship to costs of care. Am J Manag Care 1996; 2: 1239–46Google Scholar
- 11.11. American Psychiatric Association. Depression [online]. Available from URL: http://www.psych.org/public_info/depression. cfm [Accessed 2001 Jan 8]Google Scholar
- 16.Rosenbaum JF, Fava M, Nierenberg AA, et al. Treatmentresistant mood disorders. In: Gabbard GO, editor. Treatment of psychiatric disorders. 3rd ed. Washington, DC: American Psychiatric Press, 2003: 1307–88Google Scholar
- 17.Thase ME, Rush AJ. Treatment-resistant depression. In: Bloom FE, Kupfer DJ, editors. Psychopharmacology: the fourth generation of progress. New York (NY): Raven Press lid, 1995: 1081–97Google Scholar
- 18.Nierenberg AA, DeCecco L. Definitions of antidepressant treatment response, remission, nonresponse, partial response, remission, nonresponse, partial response, and other relevant outcomes: a focus on treatment-resistant depression. J Clin Psychiatry 2001; 62 Suppl. 16: 5–9Google Scholar
- 19.Sackheim HA. The definition of treatment-resistant depression. J Clin Psychiatry 2001; 62 Suppl. 16: 10–7Google Scholar
- 20.O’Reardon JP, Amsterdam ill. Treatment-resistant depression: progress and limitations. Psychiatr Ann 1998; 28 (11): 633–40Google Scholar
- 22.Greden JF. The burden of disease for treatment-resistant depression. J Clin Psychiatry 2001; 62 Suppl. 16: 26–31Google Scholar
- 29.Browne RA, Melfi CA, Croghan TW, et al. Data analysis issues to consider when conducting research using physician-reported antidepressant claims. Drug Benefit Trends 1998, 33–42Google Scholar
- 30.Kornstein SG, Schneider RK. Clinical features of treatmentresistant depression. J Clin Psychiatry 2001; 62 Suppl. 16: 18–25Google Scholar
- 31.Burton WN, Conti DJ. Use of an integrated health data warehouse to measure the employer costs of five chronic disease states. Dis Manag Health Outcomes 1998; 2 (1): 17–26Google Scholar