Janssen EMEA, Neuss, Germany.
Department of Mental Health ASL Lecce, Lecce, Italy.
J Affect Disord. 2022 Feb 1;298(Pt A):442-450. doi: 10.1016/j.jad.2021.11.004. Epub 2021 Nov 4.
Treatment resistant depression (TRD) is diagnosed when patients experiencing a major depressive episode fail to respond to ≥2 treatments. Along with substantial indirect costs, patients with TRD have higher healthcare resource utilization (HCRU) than other patients with depression. However, research on the economic impact of this HCRU, and differences according to response to treatment, is lacking.
This multicenter, observational study documented HCRU among patients with TRD in European clinical practice initiating new antidepressant treatments. Data regarding access to outpatient consultations and other healthcare resources for the first 6 months, collected using a questionnaire, were analyzed qualitatively according to response and remission status. The economic impact of HCRU, estimated using European costing data, was analyzed quantitatively.
Among 411 patients, average HCRU was higher in non-responders, attending five times more general practitioner (GP) consultations and spending longer in hospital (1.7 versus 1.1 days) than responders. Greater differences were observed according to remission status, with non-remitters attending seven times more GP consultations and spending approximately three times longer in hospital (1.7 versus 0.6 days) than remitters. Consequently, the estimated economic impacts of non-responders and non-remitters were significantly greater than those of responders and remitters, respectively.
Key limitations are small cohort size, absence of control groups and generalizability to different healthcare systems.
Patients with TRD, particularly those not achieving remission, have considerable HCRU, with associated economic impact. The costs of unmet TRD treatment needs are thus substantial, and treatment success is fundamental to reduce individual needs and societal costs.
当患者经历重度抑郁发作而对≥2 种治疗无反应时，即诊断为治疗抵抗性抑郁症（TRD）。除了大量的间接成本外，TRD 患者的医疗资源利用率（HCRU）高于其他抑郁症患者。然而，关于这种 HCRU 的经济影响以及根据治疗反应的差异的研究还很缺乏。
这项多中心、观察性研究记录了在欧洲临床实践中开始新的抗抑郁治疗的 TRD 患者的 HCRU。使用问卷收集了前 6 个月的门诊咨询和其他医疗资源使用情况的数据，根据反应和缓解状态进行了定性分析。使用欧洲成本数据进行了 HCRU 的经济影响分析。
在 411 名患者中，无反应者的平均 HCRU 较高，他们看五次普通医生（GP）就诊，住院时间也长（1.7 天比 1.1 天）。根据缓解状态，差异更大，无缓解者看七次 GP 就诊，住院时间长约三倍（1.7 天比 0.6 天）。因此，无反应者和无缓解者的估计经济影响明显大于反应者和缓解者。
关键限制是队列规模小，缺乏对照组以及对不同医疗体系的适用性。
TRD 患者，特别是未达到缓解的患者，有相当大的 HCRU，以及相关的经济影响。因此，未满足的 TRD 治疗需求的成本是巨大的，治疗成功是降低个人需求和社会成本的关键。
