Analysis Group, Inc., Montréal, Quebec, Canada.
Corresponding author: Maryia Zhdanava, MA, Analysis Group, Inc., 1190 avenue des Canadiens-de-Montréal, Deloitte Tower, Ste 1500, Montreal, QC, H3B 0G7, Canada (
J Clin Psychiatry. 2021 Mar 16;82(2):20m13699. doi: 10.4088/JCP.20m13699.
Estimates of prevalence and burden of treatment-resistant depression (TRD) vary widely in the literature. This study evaluated the prevalence and burden of TRD and the share of TRD in the burden of medication-treated major depressive disorder (MDD) using the most commonly accepted definition of TRD and a novel bottom-up approach.
Prevalence and health care burden of TRD were estimated by synthetizing inputs across 4 similarly designed claims studies in adults covered by Medicare, Medicaid, commercial plans, and the US Veterans Health Administration (VHA). Productivity (absenteeism and presenteeism) and unemployment burden were estimated based on inputs from a study conducted with data from the Kantar National Health and Wellness Survey (NHWS; 2017). A targeted literature search for additional inputs was performed. A cost model was developed to estimate the burden of TRD and medication-treated DSM-5-defined MDD in the United States. Study outcomes were the 12-month prevalence of TRD and the annual health care, productivity, and unemployment burden of TRD and medication-treated MDD in the United States.
The estimated 12-month prevalence of medication-treated MDD in the United States was 8.9 million adults, and 2.8 million (30.9%) had TRD. The total annual burden of medication-treated MDD among the US population was $92.7 billion, with $43.8 billion (47.2%) attributable to TRD. The share of TRD was 56.6% ($25.8 billion) of the health care burden, 47.7% ($8.7 billion) of the unemployment burden, and 32.2% ($9.3 billion) of the productivity burden of medication-treated MDD.
TRD is associated with disproportionate health care costs and unemployment, suggesting potentially large economic and societal gains with effective management.
文献中治疗抵抗性抑郁症（TRD）的患病率和负担估计值差异很大。本研究采用最常接受的 TRD 定义和新的自下而上的方法，评估了 TRD 的患病率和负担，以及 TRD 在药物治疗的重度抑郁症（MDD）负担中的比例。
通过综合医疗保险、医疗补助、商业计划和美国退伍军人健康管理局（VHA）覆盖的 4 项类似设计的索赔研究的数据，估计了 TRD 的患病率和医疗保健负担。根据 Kantar 国家健康与健康调查（NHWS；2017）的数据进行的一项研究的投入，估计了生产力（旷工和在职缺勤）和失业负担。进行了有针对性的文献检索以获取其他投入。开发了一个成本模型来估计美国 TRD 和药物治疗的 DSM-5 定义的 MDD 的负担。研究结果是美国 TRD 的 12 个月患病率以及美国药物治疗的 MDD 的年度医疗保健、生产力和失业负担。
美国药物治疗的 MDD 的估计 12 个月患病率为 890 万成年人，其中 280 万人（30.9％）患有 TRD。美国人口中药物治疗的 MDD 的总年度负担为 927 亿美元，其中 438 亿美元（47.2％）归因于 TRD。TRD 占药物治疗的 MDD 的医疗保健负担的 56.6％（258 亿美元），占失业负担的 47.7％（87 亿美元），占药物治疗的 MDD 的生产力负担的 32.2％（93 亿美元）。
TRD 与不成比例的医疗保健费用和失业有关，这表明有效管理可能会带来巨大的经济和社会收益。
