Incremental Burden of Relapse in Patients with Major Depressive Disorder

Objective: Assessment of incremental clinical and economic burdens of relapse in patients with major depressive disorder (MDD).

Methods: Using Magellan’s claims database (01/01/2011−09/30/2018), a real world, retrospective cohort study of commercially insured adult patients diagnosed with MDD who initiated a new antidepressant at baseline was conducted. For the 2 subcohorts (patients with or without relapse), the study assessments included: all-causes healthcare resource utilization; total costs; medication adherence during follow-up (proportion of days covered [PDC]) adherent ≥80%). Relapse was defined as: suicide attempt; psychiatric hospitalization; mental health-related emergency room (ER) visit; electroconvulsive therapy; re-initiation of treatment after a gap ≥6 months.

Results: Most patients with relapse (81.2%) were identified using the criteria “re-initiation of treatment after a gap of ≥6 months following previous antidepressant prescription.” Patients were matched for baseline characteristics (n=7093 for each subcohort), and demographics were similar between subcohorts. At follow-up, patients with relapse had significantly higher rates of hospitalization (16.6% vs 8.5%, P < 0.0001) and ER visits (54.8% vs 34.7%, P < 0.0001) than patients without relapse. The total costs for patients with relapse were significantly higher (~$12,594 vs $10,445, P < 0.0001). Patients with relapse were also significantly less adherent to antidepressants (mean PDC: 0.43 vs 0.49, P < 0.0001; adherent ≥80%: 20.2% vs 27.6%, P < 0.0001).

Conclusions: Relapse of MDD is associated with an increase in total costs and healthcare utilization, as well as with lower adherence to antidepressants. Proper management of MDD including efforts to avoid relapse may, in turn, result in a reduction of the associated healthcare burden.

This poster was presented at the 32nd annual Psych Congress, held Oct. 3-6, 2019, in San Diego, California.