Economic burden high among veterans with treatment-resistant depression

Holly Szukis

ORLANDO, Fla. — Treatment-resistant depression was associated with greater health care resource use and cost among veterans than those with non–treatment-resistant depression, according to data presented at Psych Congress.

“Nearly 40% of U.S. veterans will experience depression in their lifetime, which is three times the rate of the general U.S. population,” Holly Szukis, MPH, health economics and outcomes research specialist at Janssen Pharmaceuticals, told Healio Psychiatry. “However, despite the higher prevalence of depression in this community, there has been limited research to date to understand the economic burden and impact of treatment-resistant depression among veterans.”

In their retrospective, claims-based, matched-cohort study, Szukis and colleagues compared the economic burden of U.S. veterans with treatment-resistant depression to two control cohorts: patients with major depressive disorder (non–treatment-resistant MDD cohort); and patients without MDD (non-MDD cohort).

Researchers examined data from inpatient and outpatient health claims from the U.S. Veterans Health Administration Medical SAS Datasets from April 2014 to March 31, 2018. They evaluated health care resource use, which includes inpatient length of stay and costs (inpatient, outpatient, pharmacy, facility use and total costs), for all study cohorts.

Analysis showed that veterans with treatment-resistant depression had higher health care resource use and costs during the baseline period and during the 6-month follow-up period compared to the two control cohorts.

“Specifically, veterans with treatment-resistant depression incurred $5,906 and $11,873 higher total all-cause health care costs each year than veterans with non–treatment-resistant depression or without depression; and $4,210 and $8,651 higher mental health-related health care costs each year than veterans with non–treatment-resistant depression or without depression,” Szukis said.

Veterans with treatment-resistant depression were also 1.7 times more likely to have inpatient visits than those with non–treatment-resistant depression (95% CI, 1.57-1.83) and five times more likely than those without depression (95% CI, 4.51-5.63), according to Szukis.

Compared to veterans with MDD, those with treatment-resistant depression were more likely to have chronic pain (39.2% vs. 34.3%), anxiety (47.2% vs. 42.5%), PTSD (25.6% vs. 22.2%) and substance abuse (16.5% vs. 15.4%), as well as be prescribed antipsychotics (4.5% vs 2%) and anticonvulsants (18% vs. 14.1%). Compared with veterans without MDD, those with treatment-resistant depression were also more likely to have anxiety (47.2% vs. 11.8%), PTSD (25.6% vs. 7.6%) and substance abuse (16.5% vs. 4.3%) as well as be prescribed antipsychotics (4.5% vs. 0.4%) and anticonvulsants (18% vs. 7.1%)

“Given the disproportionate prevalence of depression among this population, the findings add to the growing body of evidence highlighting the urgency for more research and new treatment options to support the millions of people who do not respond to currently available treatments,” Szukis told Healio Psychiatry. – by Savannah Demko

References:

Szukis H, et al. Economic burden of illness among US veterans with treatment-resistant depression. Presented at: Psych Congress; Oct. 25-28, 2018; Orlando, Fla.

Disclosure: Szukis is an employee of Janssen Scientific Affairs, LLC.