Annual Cost of Major Depressive Disorder and Impact of Key Clinical Events

BACKGROUND: Patients with major depressive disorder (MDD) who experience clinical events of interest (EOIs) such as suicide attempt/ideation and hospitalization may incur greater costs. The objective of this study was to estimate all-cause healthcare costs (per patient per year [PPPY]) among MDD patients and relative to EOIs.

METHODS: Newly diagnosed adult MDD patients with antidepressant prescriptions from 2009 through 2017 were identified using IBM MarketScan Commercial databases. Follow-up ended at lapse in continuous enrollment (12-month minimum) or study end date. Clinical EOIs (e.g., antidepressant treatment changes, moderate/severe MDD or severe mental health diagnosis, MDD-related hospitalizations and ER visits, suicide attempts/ideation, and brain stimulation therapy) were captured. Mean PPPY all-cause healthcare costs were described, including cost for 90 days before and after an EOI.

RESULTS: Of 455,082 MDD patients identified, mean PPPY costs were $10,074 (outpatient medical 59%; inpatient 21%; outpatient pharmacy 20%). The most common clinical EOIs were antidepressant treatment changes (≥1 therapy; 90.1%, n=410,159), moderate/severe MDD diagnosis (23.5%, n=107,039), and MDD-related ER visits (6.1%, n=27,960). EOIs with the highest mean PPPY cost were brain stimulation therapy ($49,121), severe mental health disorder ($23,096), and MDD-related hospitalization ($15,941). For most EOIs, average costs up to 90 days following were substantially higher than those preceding, indicating EOIs as likely cost-drivers.

CONCLUSION: The substantial cost of MDD is further amplified by clinical EOIs including brain stimulation therapy, severe mental health disorder, and inpatient hospitalization. Identifying patients who experience key events may help US health plans guide targeted interventions to reduce cost of care.

This poster was presented at the 32nd annual Psych Congress, held Oct. 3-6, 2019, in San Diego, California.