Janssen Scientific Affairs, LLC, Titusville, NJ, USA.
STATinMED Research, Plano, TX, USA.
Curr Med Res Opin. 2021 Aug;37(8):1393-1401. doi: 10.1080/03007995.2021.1918073. Epub 2021 May 7.
Evidence is limited on the economic burden associated with treatment-resistant depression (TRD) among US veterans. We evaluated the economic burden among patients with major depressive disorder (MDD) with and without TRD, and those without MDD in the Veterans Health Administration (VHA).
Three cohorts were identified using VHA claims data (01APR2014-31MAR2018). Patients with MDD (aged ≥18) who failed ≥2 antidepressant treatments of adequate dose and duration were defined as having TRD; patients with MDD not meeting this criterion constituted the non-TRD MDD cohort (index: first antidepressant claim). The non-MDD cohort included those without MDD diagnosis (index: randomly assigned). Patients with psychosis, schizophrenia, manic/bipolar disorder, or dementia in the 6-month pre-index period were excluded. Patients with non-TRD MDD and non-MDD were matched 1:1 to patients with TRD based on demographic characteristics (age, gender, race, index year). Health care resource utilization (HRU) and costs were analyzed during the post-index period using a negative binomial model and ordinary least squares regression model, respectively.
After 1:1 exact matching, 10,449 patients were included in each cohort (mean age: 48.9 years). Patients with TRD had higher per patient per year (PPPY) HRU than non-TRD MDD (all-cause inpatient visits: incidence rate ratio [IRR]: 1.70 [95% confidence interval: 1.57-1.83]) and non-MDD (IRR: 5.04 [95% confidence interval: 4.51-5.63]), and incurred higher total all-cause health care costs PPPY than non-TRD MDD (mean difference: $5,906) and non-MDD (mean difference: $11,873; all <.0001).
Among US veterans, TRD poses a significant incremental economic burden relative to non-TRD MDD and non-MDD.
有关美国退伍军人中治疗抵抗性抑郁症（TRD）相关治疗负担的证据有限。我们评估了退伍军人事务部（VHA）中患有重度抑郁症（MDD）且有和无 TRD 以及无 MDD 的患者的经济负担。
使用 VHA 索赔数据（2014 年 4 月 1 日至 2018 年 3 月 31 日）确定了三个队列。至少接受了 2 种足够剂量和疗程的抗抑郁药治疗但仍失败的 MDD 患者被定义为患有 TRD；不符合此标准的 MDD 患者构成非 TRD MDD 队列（指数：首次抗抑郁药索赔）。非 MDD 队列包括无 MDD 诊断的患者（指数：随机分配）。在索引前 6 个月内患有精神病、精神分裂症、躁狂/双相障碍或痴呆的患者被排除在外。根据人口统计学特征（年龄、性别、种族、索引年份），对非 TRD MDD 和非 MDD 患者与 TRD 患者进行 1:1 匹配。使用负二项式模型和普通最小二乘法回归模型分别在索引后期间分析医疗资源利用（HRU）和成本。
在 1:1 精确匹配后，每个队列纳入了 10449 名患者（平均年龄：48.9 岁）。与非 TRD MDD（所有原因住院就诊：发生率比 [IRR]：1.70 [95%置信区间：1.57-1.83]）和非 MDD（IRR：5.04 [95%置信区间：4.51-5.63]）相比，TRD 患者的每位患者每年的 HRU 更高，并且总所有原因医疗保健费用也更高PPP 年比非 TRD MDD（平均差异：$5906）和非 MDD（平均差异：$11873；均<.0001）。
在美国退伍军人中，与非 TRD MDD 和非 MDD 相比，TRD 造成了显著的增量经济负担。
