Janssen Research & Development, LLC, Raritan, New Jersey, United States of America.
Janssen Research & Development, LLC, Titusville, New Jersey, United States of America.
PLoS One. 2020 Sep 11;15(9):e0238843. doi: 10.1371/journal.pone.0238843. eCollection 2020.
OBJECTIVE: The economic burden of commercially insured patients in the United States with treatment-resistant depression and patients with non-treatment-resistant major depressive disorder was compared using data from the Optum Clinformatics™ claims database. METHODS: Patients 18-63 years on antidepressant treatment between 1/1/13 and 9/30/13, who had no treatment claims for depression 6 months before the index date (first antidepressant dispensing), and who had a major depressive disorder or depression diagnosis within 30 days of the index date, were included. Treatment-resistant depression was defined as receiving 3 antidepressant regimens during 1 major depressive disorder episode. Patients with treatment-resistant depression were matched with patients with non-treatment-resistant major depressive disorder at a 1:4 ratio using propensity score matching. The study consisted of 1-year baseline (pre-index) and 2-year follow-up (post index) periods. Cost outcomes were compared using a generalized linear model. RESULTS: 2,370 treatment-resistant depression and 9,289 non-treatment-resistant major depressive disorder patients were included. In year 1 of the follow-up period, compared with non-treatment-resistant major depressive disorder, patients with treatment-resistant depression had: more emergency department visits (odds ratio = 1.39, 95% confidence interval = 1.24-1.56); more inpatient hospitalizations (odds ratio = 1.73, 95% confidence interval = 1.46-2.05); longer hospital stays (mean difference vs non-treatment-resistant major depressive disorder = 2.86, 95% confidence interval = 0.86-4.86 days); and more total healthcare costs (mean difference vs non-treatment-resistant major depressive disorder = US$3,846, 95% confidence interval = $2,855-$4,928). These patterns remained consistent in year 2 of the follow-up period. CONCLUSION: Treatment-resistant depression was associated with higher healthcare resource utilization and costs versus non-treatment-resistant major depressive disorder in this commercially insured cohort of patients in the United States.
目的：使用 Optum Clinformatics™ 索赔数据库中的数据，比较美国商业保险患者中治疗抵抗性抑郁症患者和非治疗抵抗性重度抑郁症患者的经济负担。
方法：纳入 2013 年 1 月 1 日至 2013 年 9 月 30 日期间接受抗抑郁治疗且在索引日期前 6 个月无抑郁治疗索赔的年龄在 18-63 岁之间的患者，且在索引日期后 30 天内有重度抑郁症或抑郁诊断。治疗抵抗性抑郁症定义为在 1 次重度抑郁症发作期间接受 3 种抗抑郁药治疗方案。采用倾向评分匹配以 1:4 的比例将治疗抵抗性抑郁症患者与非治疗抵抗性重度抑郁症患者相匹配。该研究包括 1 年的基线（前索引）和 2 年的随访（后索引）期。使用广义线性模型比较成本结果。
结果：纳入了 2370 例治疗抵抗性抑郁症患者和 9289 例非治疗抵抗性重度抑郁症患者。在随访期的第 1 年，与非治疗抵抗性重度抑郁症患者相比，治疗抵抗性抑郁症患者：急诊就诊次数更多（比值比=1.39，95%置信区间=1.24-1.56）；住院次数更多（比值比=1.73，95%置信区间=1.46-2.05）；住院时间更长（与非治疗抵抗性重度抑郁症相比的平均差异=2.86，95%置信区间=0.86-4.86 天）；总医疗保健费用更高（与非治疗抵抗性重度抑郁症相比的平均差异=3846 美元，95%置信区间=2855-4928 美元）。这些模式在随访期的第 2 年仍然保持一致。
结论：与非治疗抵抗性重度抑郁症患者相比，在美国这个商业保险患者队列中，治疗抵抗性抑郁症与更高的医疗资源利用和成本相关。
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