Costs Associated with Inadequate Response to Treatment for MDD

Philadelphia—In addition to negative impact on physical health, major depressive disorder (MDD) is associated with chronic impairment of psychosocial and occupational functioning, creating a substantial economic burden due to treatment-related costs, illness-related unemployment, and reduced work productivity.

MDD is a highly prevalent disorder, with a lifetime incidence of nearly 16%. Direct and indirect costs related to MDD in the United States are estimated to be >$40 billion.

Clinical trials have demonstrated the challenges of treating MDD, with 50% to 70% of patients failing to achieve remission following treatment with ≥1 antidepressant of adequate dosage and duration.

Noting that data on the economic consequences of inadequate response to therapy for MDD with antidepressants are scarce, researchers recently conducted a systematic literature review of the economic costs in the United States for patients with MDD who were inadequate responders to antidepressant therapy. They reported results of the review at a poster session at the APA meeting. The poster was titled Systematic Literature Review of Economic Costs in the United States of Major Depressive Disorder in Adults Who Are Inadequate Responders to Initial Treatment.

A search to identify economic evaluations of patients who were inadequate responders to selective serotonin reuptake inhibitors or serotonin and norepinephrine reuptake inhibitor treatments was conducted using MEDLINE, EMBASE, The Cochrane Library, EconLit, the National Health Service Economic Evaluation Database, and the Health Economic Evaluations Database for articles published between January 2000 and February 2011. In addition, relevant conference websites were manually searched for abstracts presented between January 2008 and February 2011.

The literature searches yielded a total of 7243 titles; after applying inclusion and exclusion criteria, 11 relevant US-specific cost-of-illness studies were identified, with cost-years ranging from 1994 to 2007. Of the 11 relevant studies, 7 were database analyses, 2 were based on retrospective survey data, and 2 were based on economic data collection within a clinical trial of a therapy.

The literature review found that direct costs, such as those for medication, physician consultation, and hospitalization, were higher for patients who were partial or nonresponders compared with patients who attained remission. For partial responders, annual mean total healthcare costs ranged from $3459 to $3564 per person; the costs for nonresponders were $3324 to $8661. For those who attained remission, the costs ranged from $1332 to $2816.

Among patients who switched treatment, direct costs were up to 54% higher than for patients who remained on their initial antidepressant therapy. Patients who had treatment-resistant depression (TRD), defined as treatment failure after ³2 adequate antidepressant trials, had the highest annual mean total healthcare costs ($8506 to $10,377).

For both partial responders and nonresponders, mean loss in productivity (days of work missed) was 1.4 to 2.7 times higher per person than for patients in remission.

Review limitations cited by the researchers included basing definitions of partial responders and nonresponders on varying outcome measures, a slight variation in the definition of MDD across the studies included in the review, and confounding the synthesis of medical healthcare cost estimates by “substantial methodological heterogeneity between studies and by diversity in the scope of resource items included.”

The researchers summarized their findings, stating, “despite some differences in definition of inadequate or nonresponse, a consistent finding was that health costs were higher in partial responders, nonresponders, and TRD groups compared with remitters.”

“Thus, treatment patterns achieving remission earlier appear to be cost-saving for patients with MDD and there is a need to achieve adequate control across the full spectrum of MDD.”

This study was supported by AstraZeneca.