, Volume 22, Issue 6, pp 363–373 | Cite as

Economic Implications of Treatment-Resistant Depression Among Employees

  • Paul GreenbergEmail author
  • Patricia K. Corey-Lisle
  • Maryna Marynchenko
  • Ami Claxton
Original Research Article


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.


Major Depressive Disorder Major Depressive Disorder Claim Data Major Depressive Disorder Patient Medical Claim 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



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.


  1. 1.
    Hirschfeld RMA, Montgomery SA, Keller MB, et al. Social functioning in depression: a review. J Clin Psychiatry 2000; 61 (4),268–75PubMedCrossRefGoogle Scholar
  2. 2.
    Greenberg PE, Stiglin LE, Finkelstein SN, et al. The economic burden of depression in 1990. J Clin Psychiatry 1993; 54: 405–18PubMedGoogle Scholar
  3. 3.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association, 1994Google Scholar
  4. 4.
    Kessler RC, McGonagle KA, Zhao S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Arch Gen Psychiatry 1994; 51: 8–191PubMedCrossRefGoogle Scholar
  5. 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
  6. 6.
    Greenberg PE, Leong SA, Birnbaum HG. Cost of depression: current assessment and future directions. Exp Rev Pharmacoeconomics Outcomes Res 2001; 1 (1): 69–76CrossRefGoogle Scholar
  7. 7.
    Mitchell J, Greenberg J, Finch K, et al. Effectiveness and economic impact of antidepressant medications: a review. Am J Manag Care 1997; 3 (2): 323–30PubMedGoogle Scholar
  8. 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
  9. 9.
    Sclar DA, Robison LM, Skaer TL, et al. Antidepressant pharmacotherapy: economic outcomes in a health maintenance organization. Clin Ther 1994; 16 (4): 715–30PubMedGoogle Scholar
  10. 10.
    Simon GE, Revicki D, Heiligenstein J, et al. Recovery from depression, work productivity, and health care costs among primary care patients. Gen Hosp Psychiatry 2000; 22: 153–62PubMedCrossRefGoogle Scholar
  11. 11.
    11. American Psychiatric Association. Depression [online]. Available from URL: cfm [Accessed 2001 Jan 8]Google Scholar
  12. 12.
    Sourey D, Amsterdam J, de Montigny C, et al. Treatment resistant depression: methodological overview and operational criteria. Eur Neuropsychopharmacol 1999; 9 (1–2): 83–91CrossRefGoogle Scholar
  13. 13.
    Rush AJ, Crismon ML, Toprac MG, et al. Consensus guidelines in the treatment of major depressive disorder. J Clin Psychiatry 1998; 59 Suppl. 20: 73–84PubMedCrossRefGoogle Scholar
  14. 14.
    Thase ME, Friedman ES, Howland RH. Venlafaxine and treatment-resistant depression. Depress Anxiety 2000; 12 Suppl. 1: 55–62PubMedCrossRefGoogle Scholar
  15. 15.
    Dyck MJ. Treatment-resistant depression: a critique of current approaches. Aust N Z J Psychiatry 1994; 28: 34–41PubMedCrossRefGoogle Scholar
  16. 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. 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. 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. 19.
    Sackheim HA. The definition of treatment-resistant depression. J Clin Psychiatry 2001; 62 Suppl. 16: 10–7Google Scholar
  20. 20.
    O’Reardon JP, Amsterdam ill. Treatment-resistant depression: progress and limitations. Psychiatr Ann 1998; 28 (11): 633–40Google Scholar
  21. 21.
    Corey-Lisle PK, Birnbaum H, Greenberg PE, et al. Identification of claims data ‘signature’ and economic consequences for treatment-resistant depression. J Clin Psychiatry 2002; 63: 717–26PubMedCrossRefGoogle Scholar
  22. 22.
    Greden JF. The burden of disease for treatment-resistant depression. J Clin Psychiatry 2001; 62 Suppl. 16: 26–31Google Scholar
  23. 23.
    Fava M, Davidson KG. Definition and epidemiology of treatment-resistant depression. Psychiatr Clin North Am 1996; 19 (2), 179–98PubMedCrossRefGoogle Scholar
  24. 24.
    Thase M. What role do atypical antipsychotic drugs have in treatment-resistant depression? J Clin Psychiatry 2002; 63 (2): 95–103PubMedCrossRefGoogle Scholar
  25. 25.
    Austin M, Souza F, Goodwin G. Lithium augmentation in antidepressant-resistant patients: a quantitative analysis. Br J Psychiatry 1991; 159: 510–4PubMedCrossRefGoogle Scholar
  26. 26.
    Nierenberg A, Feighner J, Rudolph R, et al. Venlafaxine for treatment-resistant unipolar depression. J Clin Psychopharmacol 1994; 14 (6): 419–23PubMedCrossRefGoogle Scholar
  27. 27.
    Sackeim H, Rush A, George MS, et al. Vagus nerve stimulation (VNS) for treatment-resistant depression: efficacy, side effects, and predictors of outcome. Neuropsychopharmacology 2001; 25 (5): 713–28PubMedCrossRefGoogle Scholar
  28. 28.
    Rost K, Smith R, Matthew DB, et al. The deliberate misdiagnosis of major depression in primary care. Arch Fam Med 1994; 3: 333–7PubMedCrossRefGoogle Scholar
  29. 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. 30.
    Kornstein SG, Schneider RK. Clinical features of treatmentresistant depression. J Clin Psychiatry 2001; 62 Suppl. 16: 18–25Google Scholar
  31. 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
  32. 32.
    Barnett A, BirnbaumH, Cremieux PY, et al. The costs of cancer to a major employer in the United States: a case-control analysis. Am J Manag Care 2000; 6 (11): 1243–51PubMedGoogle Scholar

Copyright information

© Adis Data Information BV 2004

Authors and Affiliations

  • Paul Greenberg
    • 1
    Email author
  • Patricia K. Corey-Lisle
    • 2
  • Maryna Marynchenko
    • 1
  • Ami Claxton
    • 3
  1. 1.Analysis Group Inc.BostonUSA
  2. 2.Bristol Myers SquibbWallingfordUSA
  3. 3.PPD DevelopmentMorrisvilleUSA

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