Depression Treatment Failure Burdens Patients' Life and Wallets

NEW ORLEANS -- Depressed patients with prior treatment failure often face high medical costs and poor quality of life, a new survey suggested.

Of 10,710 adults with self-reported major depressive disorder (MDD) who participated in the 2019 National Health and Wellness Survey, 1,077 said they experienced treatment failure requiring them to try new medications as a result of non-responsiveness, Larry Culpepper, MD, of Boston University School of Medicine, and colleagues reported at Psych Congress 2022.

Among these patients who experienced depression treatment failure, many reported low quality of life and high medical costs.

However, those with more severe cases of depression tended to carry more of these burdens. For example, in a comparison of scores from three quality-of-life measures, those with severe major depressive disorder saw significantly lower marks compared with those with milder disease:

• Short Form (SF)-36v2 mental component: 21.8 points for severe MDD vs 42.3 for mild MDD

• SF-36v2 physical component: 43.9 points for severe MDD vs 47.8 for mild MDD

• EuroQol 5-Dimension Visual Analogue score: 45.3 points for severe MDD vs 67.6 for mild MDD

On top of that, patients with severe MDD who experienced prior treatment failure also faced significantly higher direct and indirect medical costs. Patients with mild MDD with prior treatment failure saw average direct medical costs -- including factors like emergency department visits, healthcare provider visits, and hospitalizations -- of $9,447 on average. These direct medical costs increased to $10,428 for moderate MDD, dropped slightly to $8,673 for moderate-severe MDD, but then topped off at $13,971 for severe MDD.

These direct medical costs were calculated by multiplying the average unit cost, as reported by the Medical Expenditure Panel Survey, by the number of each type of visit.

Average indirect medical costs -- including factors such as the cost of presenteeism and absenteeism at work -- followed a similar pattern:

• $3,027 for mild MDD

• $4,985 for moderate MDD

• $5,131 for moderate-severe MDD

• $7,271 for severe MDD

Indirect costs were calculated by taking the number of work hours missed due to health (representing absenteeism) plus the number of work hours with decreased productivity because of health problems (representing presenteeism) and multiplying these by median hourly wages set forth by the Bureau of Labor Statistics.

"The key takeaway from this analysis was that among patients who report a prior treatment failure, there is a high humanistic burden in terms of poor health-related quality of life as well as high direct medical and indirect costs," Mousam Parikh, MSc, director of health economics outcomes research for psychiatry at AbbVie, who presented the results, explained to MedPage Today.

"This data analysis reinforces the need to routinely monitor patient-centric outcomes such as health-related quality of life and work productivity impacts among patients with a prior failure to MDD treatment, regardless of disease severity," she added.

Although the researchers weren't necessarily surprised by the findings, given the fact that MDD is often "a significant burden" on the healthcare system, Parikh said they "were surprised by the high humanistic and economic burden for patients with mild MDD who self-reported a prior treatment failure."

"Given that patients with MDD may often cycle through different treatment options over the course of their disease journey, these results reflect the considerable unmet need experienced by these patients," she pointed out.

Parikh also highlighted that it's still important to recognize that even those who experienced treatment failure for just mild MDD reported poor outcomes.

"Additionally, the high proportion of patients in this analysis reporting a comorbidity of anxiety disorder emphasizes the need for early effective therapy as these patients could have poorer patient outcomes compared to patients without comorbid mental health disorders," she noted.

Across the range of MDD severity, comorbid anxiety was quite common, affecting:

• 62.7% of those with mild MDD

• 77.9% of those with moderate MDD

• 81.3% of those with moderate-severe MDD

• 87.6% of those with severe MDD

Beyond anxiety, patients with treatment-failure MDD tended to see a high rate of many comorbidities, including panic disorder, phobias, post-traumatic stress disorder, social anxiety, attention deficit disorder, and obsessive-compulsive disorder.

All respondents to the survey were U.S. residents ages 18 and older. MDD was defined as a self-reported physician diagnosis for depression, and those with bipolar I disorder or schizophrenia in the past 12 months were excluded.

Of this cohort, 48% had mild MDD (Patient Health Questionnaire-9 score of 0-9), 22.66% had moderate MDD (score of 10-14), 17.36% had moderate-severe MDD (score of 15-19), and 11.98% had severe MDD (score of 20 or above). More white patients had mild than severe disease (84.3% vs 74.4%), while Black patients were more likely to have severe MDD (3.1% vs 7.8%), the researchers reported.

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