Broadstreet HEOR, Vancouver, BC, Canada.
The University of Manchester, Manchester, UK.
J Affect Disord. 2019 Jan 1;242:195-210. doi: 10.1016/j.jad.2018.06.045. Epub 2018 Jun 27.
Major depressive disorder (MDD) is a global public health concern. In particular, treatment-resistant depression (TRD) represents a key unmet need in the management of MDD. A systematic review of the epidemiological and economic literature on the burden associated with an increasing number of treatment steps due to TRD/non-response within an MDD episode was performed to quantify the burden of TRD.
Studies were identified in the PubMed/Medline databases through April 27th, 2017. Articles were limited to full-length peer-reviewed journal publications with no date restrictions. Economic and patient health-related quality of life (HRQoL) data on non-response by the number of treatment steps were quantified and, where appropriate, compared across studies; otherwise, comparative data within studies were reported.
The 12 studies on economic burden found an association between increasing levels of TRD/non-response and elevations in direct and indirect costs. Likewise, the 19 studies studying HRQoL burden found that increasing levels of TRD/non-response correlated with reduced patient HRQoL and health status.
TRD is defined inconsistently, which results in notable heterogeneity between published studies and poses methodological challenges for between-study comparisons. It is unknown if the increased economic and patient HRQoL burden are due to factors associated with TRD/non-response in addition to those due to depression persistence or severity.
A consistent trend was observed such that medical costs increased and patient HRQoL and health status decreased by increasing level of TRD/non-response within an MDD episode. These findings highlight the need for improved therapies for TRD to help reduce disease burden.
重度抑郁症（MDD）是一个全球性的公共卫生问题。尤其是，治疗抵抗性抑郁症（TRD）代表了 MDD 管理中一个关键的未满足的需求。对与 TRD/无反应相关的负担的流行病学和经济文献进行了系统综述，以量化 TRD 的负担。
通过 2017 年 4 月 27 日的 PubMed/Medline 数据库确定研究。文章仅限于同行评审的全文期刊出版物，没有日期限制。对 MDD 发作中因 TRD/无反应而增加的治疗步骤数量的非反应的经济和患者健康相关生活质量（HRQoL）数据进行了量化，并在适当的情况下在研究之间进行了比较；否则，报告了研究内的比较数据。
12 项关于经济负担的研究发现，TRD/无反应程度的增加与直接和间接成本的增加之间存在关联。同样，19 项研究 HRQoL 负担发现，TRD/无反应程度的增加与患者 HRQoL 和健康状况的降低相关。
TRD 的定义不一致，这导致发表的研究之间存在明显的异质性，并对研究之间的比较提出了方法学挑战。尚不清楚增加的经济和患者 HRQoL 负担是否是由于除了抑郁持续时间或严重程度以外的与 TRD/无反应相关的因素所致。
在 MDD 发作中，TRD/无反应程度的增加观察到一致的趋势，即医疗费用增加，患者的 HRQoL 和健康状况下降。这些发现强调了需要改善 TRD 的治疗方法，以帮助减轻疾病负担。
