Health care costs rise with symptom severity in patients with MDD, TRD
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As symptom severity for major depressive disorder and treatment-resistant depression increases, so do costs to health systems, according to a retrospective cohort study published in the Journal of Clinical Psychiatry.
“Cost studies of TRD typically use diagnostic data to categorize patients; however, this approach does not account for variation in symptoms within diagnostic categories,” Frances L. Lynch, PhD, MSPH, from the Center for Health Research at Kaiser Permanente Northwest, and colleagues wrote.
“Patients diagnosed with MDD may have symptoms ranging from low to very severe; this is not reflected in diagnosis codes. The use of patient-reported outcomes presents an opportunity to study the economic impact of depression from a new perspective.”
Lynch and colleagues conducted a retrospective cohort study to uncover if measuring severity of depression symptoms can improve understanding of incurred health care costs in patients diagnosed with MDD or TRD.
The study included participants aged 18 years and older, split into two mutually exclusive cohorts, one of adults diagnosed with TRD and the other of adults with MDD without TRD. Depression severity for both was gauged by self-reporting through the Patient Health Questionnaire-9. The researchers compared patterns of health care resource utilization and subsequent costs between the TRD and MDD groups overall and within each group at different symptom levels. The study took place from January 2014 to December 2017, and all participants had to have at least two scores from the PHQ-9 within that period. Patients were followed for 12 months following their index dates.
Results showed that patients with TRD incurred health care costs 1.23 times greater (95% CI, 1.21–1.26; P<.001) than the MDD group on average within the 12 month follow-up. Participants who reported more severe symptoms in both groups recorded higher mean costs as well (TRD: moderate: $12,429 [$23,900] vs severe: $13,344 [$22,895], P<.001; low: $12,220 [$31,864] vs severe: $13,344 [$22,895], P<.001; MDD: moderate: $8,899 [$20,755] vs severe: $10,098 [$22,853]; P<.001; low: $8,752 [$25,800] vs severe: $10,098 [$22,853], P<.001).
Data additionally showed that patients in the TRD cohort had greater comorbidity than those in the MDD cohort.
“This additional information about the burden of TRD and MDD, and subgroups of patients with different levels of symptoms within these groups, could aid in planning of clinical care by helping to target interventions to the persons most in need,” Lynch and colleagues wrote.