Economic Burden of Illness Among US Veterans With Treatment-Resistant Depression

Background: Limited evidence is available regarding the economic burden associated with treatment-resistant depression (TRD) among US Veterans.
Objective: To compare the economic burden of major depressive disorder (MDD) patients with TRD to patients with non-TRD MDD and non-MDD in the Veterans Health Administration (VHA) population.
Methods: Three cohorts were identified using VHA claims data (01APR2014-31MAR2018). MDD patients (aged ≥18) who failed ≥2 antidepressant (AD) treatments of adequate dose and duration were defined as TRD, while MDD patients not meeting this criterion constituted the non-TRD MDD cohort (index: first AD claim). The non-MDD cohort included those without a MDD diagnosis (index: randomly assigned). Patients with psychosis, schizophrenia, manic/bipolar disorder, or dementia in the 6-month pre-index period were excluded. Non-TRD MDD and non-MDD patients were matched 1:1 to TRD patients based on demographic characteristics. Health care resource utilization (HRU) and costs were analyzed during the post-index period using a generalized linear model and ordinary least squares regression model, respectively.
Results: Each cohort included 10,449 matched patients (mean age: 48.9 years). After baseline adjustment, TRD patients had higher per patient per year (PPPY) HRU than non-TRD MDD (all-cause inpatient visits: incidence rate ratio [IRR]: 1.70 [95% CI: 1.57-1.83]) and non-MDD patients (IRR: 5.04 [95% CI: 4.51-5.63]). TRD patients incurred higher total all-cause healthcare costs PPPY than non-TRD MDD (mean difference: $5,906) and non-MDD patients (mean difference: $11,873) (all p<0.0001).
Conclusions: These results add to the cost-of-illness literature by demonstrating an unmet need and the importance for novel treatment for US Veterans with TRD.