Janssen Scientific Affairs, LLC (CB, HS, JJS, LA), Titusville, NJ.
Janssen Scientific Affairs, LLC (CB, HS, JJS, LA), Titusville, NJ.
Am J Geriatr Psychiatry. 2020 Mar;28(3):350-362. doi: 10.1016/j.jagp.2019.10.012. Epub 2019 Oct 22.
To compare the clinical and economic burden of treatment-resistant depression (TRD) among older adult patients with major depressive disorder (MDD) to non-TRD MDD and non-MDD patients.
Retrospective cohort study using 5% Medicare data (January 1, 2012-December 31, 2015) for MDD patients aged ≥65 years who were defined as TRD if they received ≥2 antidepressant treatments in the current episode. MDD patients not meeting TRD criteria were deemed non-TRD MDD; those without an MDD diagnosis were categorized as non-MDD. All were required to have continuous health plan enrollment for ≥6 months pre- and ≥12 months postindex date (index: first antidepressant claim/random [non-MDD]). Three cohorts were matched, and generalized linear and Cox proportional hazards models were used to compare medication use, healthcare resource utilization, costs, and risks of initial hospitalization and readmission ≤30 days postdischarge from initial hospitalization.
After matching, 178 patients from each cohort were analyzed. During 12 months of follow-up, TRD patients had higher use of different antidepressants and antipsychotics, higher inpatient and emergency room visits, longer inpatient stays, and higher total healthcare costs ($24,543 versus $16,059, $8,058) than non-TRD MDD and non-MDD cohorts, respectively (all p <0.05). Risk of initial hospitalization was higher in the TRD (hazard ratio [HR] = 3.60, 95% confidence interval [CI] = 2.08-6.23) and non-TRD MDD cohorts (HR = 1.82, 95% CI = 1.02-3.25) than the non-MDD cohort.
The burden of MDD among older adult Medicare beneficiaries is substantial, and even greater among those with TRD compared to non-TRD MDD, demonstrating the need for more effective treatments than those currently available.
比较老年抑郁症（MDD）患者中治疗抵抗性抑郁症（TRD）与非 TRD MDD 和非 MDD 患者的临床和经济负担。
采用 5%的 Medicare 数据（2012 年 1 月 1 日至 2015 年 12 月 31 日）进行回顾性队列研究，纳入年龄≥65 岁的 MDD 患者，若当前发作中接受≥2 种抗抑郁药治疗则定义为 TRD。不符合 TRD 标准的 MDD 患者被认为是非 TRD MDD；未诊断为 MDD 的患者被归类为非 MDD。所有患者均要求在索引日期（索引：首次抗抑郁药申请/随机[非 MDD]前≥6 个月和后≥12 个月）前有≥6 个月的连续健康计划参保。对三组患者进行匹配，并使用广义线性和 Cox 比例风险模型比较药物使用、医疗资源利用、成本以及首次住院后 30 天内再次住院的风险。
匹配后，每组分析了 178 例患者。在 12 个月的随访期间，与非 TRD MDD 和非 MDD 队列相比，TRD 患者使用了更多不同的抗抑郁药和抗精神病药，住院和急诊就诊次数更多，住院时间更长，总医疗费用更高（分别为$24543 比$16059，$8058）（均 p <0.05）。TRD（风险比[HR] = 3.60，95%置信区间[CI] = 2.08-6.23）和非 TRD MDD 队列（HR = 1.82，95% CI = 1.02-3.25）的初始住院风险均高于非 MDD 队列。
老年 Medicare 受益人的 MDD 负担很大，而与非 TRD MDD 相比，TRD 患者的负担更大，这表明需要比目前可用的治疗方法更有效的治疗方法。
