Analysis Group Inc., Montréal, Canada.
Integrated Resources Inc., Edison, NJ, USA.
Curr Med Res Opin. 2021 Jan;37(1):123-133. doi: 10.1080/03007995.2020.1844645. Epub 2020 Nov 18.
To assess the burden of treatment-resistant depression (TRD) among privately insured patients with anxiety disorder and/or substance use disorders (SUD).
Adults <65 years old were identified in the Optum Health Care Solutions Inc. database (July 2009-March 2017). Among those with major depressive disorder (MDD) and antidepressant use, patients who initiated a third antidepressant (index date) after two regimens at adequate dose and duration were classified in the TRD cohort and patients without evidence of TRD were classified in the non-TRD MDD control cohort. The non-MDD control cohort comprised patients without MDD. In the non-TRD MDD and non-MDD cohorts, the index date was imputed to mimic the distribution of time in the TRD cohort from the first antidepressant to the index date or from the start of eligibility to the index date, respectively. Patients with <6 months of continuous insurance eligibility pre-/post-index, psychosis, schizophrenia, bipolar disorder and related conditions, dementia, and development disorders, and/or no baseline anxiety disorder and/or SUD were excluded. Patients with TRD were matched 1:1 to patients with non-TRD MDD and patients without MDD, based on exact matching factors (i.e. availability of work loss data) and propensity scores computed based on characteristics measured pre-index. Outcomes, including healthcare resource use (HRU) and costs, work productivity loss and related costs measured per patient per year ≤24 months post-index were compared between matched TRD, non-TRD MDD and non-MDD cohorts.
A total of 3166 patients were identified in the TRD cohort and matched to non-TRD MDD and non-MDD cohorts. Among patients with TRD (mean age 39 years, 60.5% female), 87.3% had an anxiety disorder, 24.1% had SUD. The TRD cohort had higher HRU vs non-TRD MDD and non-MDD cohorts: 0.32 vs 0.20 and 0.14 inpatient admissions, 0.91 vs 0.73 and 0.58 emergency department visits, and 23.8 vs 16.8 and 11.6 outpatient visits, respectively (all < .01). The TRD cohort had higher healthcare costs ($16,674) vs non-TRD MDD ($10,945) and non-MDD ($6493) cohorts (all < .01). Among patients with work loss data ( = 310/cohort), patients with TRD had more work loss days (54) and higher work loss-related costs ($13,674) vs patients with non-TRD MDD (32 days; $7131) and without MDD (17 days; $4798; all < .01).
In patients with an anxiety disorder and/or SUD, TRD was associated with higher HRU, healthcare costs, work loss days and work loss-related costs.
评估伴有焦虑障碍和/或物质使用障碍（SUD）的私人保险患者中治疗抵抗性抑郁症（TRD）的负担。
在 Optum Health Care Solutions Inc. 数据库（2009 年 7 月至 2017 年 3 月）中确定年龄<65 岁的成年人。在有重大抑郁障碍（MDD）和抗抑郁药使用史的患者中，在充分剂量和持续时间的两种方案后开始使用第三种抗抑郁药（索引日期）的患者被归入 TRD 队列，而无 TRD 证据的患者归入非 TRD MDD 对照组。非 MDD 对照组包括无 MDD 的患者。在非 TRD MDD 和非 MDD 队列中，索引日期被推测为从第一种抗抑郁药到索引日期或从合格开始到索引日期的时间分布，分别为。排除<6 个月的连续保险资格前/后、精神病、精神分裂症、双相情感障碍及相关疾病、痴呆和发育障碍和/或无基线焦虑障碍和/或 SUD 的患者。根据确切匹配因素（即是否有工作损失数据）和基于索引前测量的特征计算的倾向得分，TRD 患者与非 TRD MDD 和非 MDD 患者 1:1 匹配。匹配后的 TRD、非 TRD MDD 和非 MDD 队列中，≤24 个月的每个患者每年的医疗资源使用（HRU）和成本、工作生产力损失和相关成本的比较。
共纳入 3166 例 TRD 队列患者，并与非 TRD MDD 和非 MDD 队列相匹配。在 TRD 患者中（平均年龄 39 岁，女性占 60.5%），87.3%有焦虑障碍，24.1%有 SUD。TRD 队列的 HRU 高于非 TRD MDD 和非 MDD 队列：0.32 比 0.20 和 0.14 次住院，0.91 比 0.73 和 0.58 次急诊就诊，23.8 比 16.8 和 11.6 次门诊就诊（均<0.01）。TRD 队列的医疗费用（$16674）高于非 TRD MDD 队列（$10945）和非 MDD 队列（$6493）（均<0.01）。在有工作损失数据的患者中（n=310/队列），TRD 患者的工作损失天数（54 天）和工作损失相关费用（$13674）高于非 TRD MDD 患者（32 天；$7131）和无 MDD 患者（17 天；$4798；均<0.01）。
在伴有焦虑障碍和/或 SUD 的患者中，TRD 与更高的 HRU、医疗费用、工作损失天数和工作损失相关费用相关。
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