Dataset Information

The Increasing Economic Burden with Additional Steps of Pharmacotherapy in Major Depressive Disorder.

ABSTRACT:

Objectives

Major depressive disorder (MDD) is a common and serious disorder with significant impact on patients and families. The goal of this retrospective cohort study was to determine the economic burden among patients with MDD stratified by number of treatment lines needed for episode resolution.

Methods

Truven Health Analytics MarketScan^® claims data were used to identify US patients (≥ 18 years) who were diagnosed with MDD and started on an antidepressant between 2013 and 2017. A generalized linear model estimated direct and employment-related costs for the first 12 months following initiation of treatment across cohorts with increasing number of lines of MDD pharmacotherapy. Analyses were adjusted for demographics and clinical factors.

Results

A total of 73,597 patients with MDD comprising the commercial (n = 66,459) and Medicare (n = 7138) populations met selection criteria. Patients who completed treatment for their episode with a single line of antidepressant had the lowest total adjusted direct costs (commercial $9975; Medicare $14,628) followed by those who completed with two lines (commercial $11,723; Medicare $15,526) and those treated with three or more lines of antidepressant regimens (commercial $21,259; Medicare $20,964). Patients who completed treatment with two lines as opposed to one incurred significantly higher direct costs (commercial +$1748, p < 0.0001; Medicare +$898, p = 0.0092). Patients who completed treatment with one line had the lowest employment-related costs compared to other groups.

Conclusions

There was an increased economic burden associated with delay of episode resolution as early as the second line compared to the first line in MDD.

SUBMITTER: Arnaud A

PROVIDER: S-EPMC8166719 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BackgroundThe incremental economic burden of US adults with major depressive disorder (MDD) was estimated at $US210.5 billion in 2010 (year 2012 values).ObjectiveFollowing a similar methodology, this study updates the previous findings with more recent data to report the economic burden of adults with MDD in 2018.MethodThis study used a framework for evaluating the incremental economic burden of adults with MDD in the USA that combined original and literature-based estimates, focusing on key changes between 2010 and 2018. The prevalence rates of MDD by sex, age, employment, and treatment status over time were estimated based on the National Survey on Drug Use and Health (NSDUH). The incremental direct and workplace costs per individual with MDD were primarily derived from administrative claims data and NSDUH data using comparative analyses of individuals with and without MDD. Societal direct and workplace costs were extrapolated by multiplying NSDUH estimates of the number of people with MDD by the direct and workplace cost estimates per patient. The suicide-related costs were estimated using a human capital method.ResultsThe number of US adults with MDD increased by 12.9%, from 15.5 to 17.5 million, between 2010 and 2018, whereas the proportion of adults with MDD aged 18-34 years increased from 34.6 to 47.5%. Over this period, the incremental economic burden of adults with MDD increased by 37.9% from $US236.6 billion to 326.2 billion (year 2020 values). All components of the incremental economic burden increased (i.e., direct costs, suicide-related costs, and workplace costs), with the largest growth observed in workplace costs, at 73.2%. Consequently, the composition of 2018 costs changed meaningfully, with 35% attributable to direct costs (47% in 2010), 4% to suicide-related costs (5% in 2010), and 61% to workplace costs (48% in 2010). This increase in the workplace cost share was consistent with more favorable employment conditions for those with MDD. Finally, the proportion of total costs attributable to MDD itself as opposed to comorbid conditions remained stable at 37% (38% in 2010).ConclusionWorkplace costs accounted for the largest portion of the growing economic burden of MDD as this population trended younger and was increasingly likely to be employed. Although the total number of adults with MDD increased from 2010 to 2018, the incremental direct cost per individual declined. At the same time, the proportion of adults with MDD who received treatment remained stable over the past decade, suggesting that substantial unmet treatment needs remain in this population. Further research is warranted into the availability, composition, and quality of MDD treatment services.

Project description:Background: Major Depressive Disorder (MDD) is a moderately heritable disorder with a high lifetime prevalence. At present, laboratory blood tests to support MDD diagnosis are not available. Methods: We used a classifier approach on blood gene expression profiles of a unique set of non-medicated subjects (MDD patients and controls) to select genes of which expression is predictive for disease status. To reveal blood gene expression changes related to MDD disease, we applied a powerful ex vivo stimulus to the blood, i.e. incubation with lipopolysaccharide (LPS; 10 ng/ml blood). Results: Based on LPS-stimulated blood gene expression using whole-genome microarrays in 42 subjects (primary cohort; 21 MDD patients (mean age 42.3 years), 21 healthy controls (mean age 41.9 years)), we identified a set of genes (CAPRIN1, CLEC4A, KRT23, MLC1, PLSCR1, PROK2, ZBTB16) that serves as a molecular signature of MDD. These findings were validated for the primary cohort using an independent quantitative PCR method (P = 0.007). The difference between depressive patients and controls was confirmed (P = 0.019) in a replication cohort of 13 patients with MDD (mean age 42.8 years) and 14 controls (mean age 45.6 years). The MDD-signature score comprised of expression levels of 7 genes could discriminate depressive patients from controls with sensitivity of 76.9% and specificity of 71.8%. Conclusions: We show for the first time that molecular analysis of stimulated blood cells can be used as an endophenotype for MDD diagnosis, which is a milestone in establishing biomarkers for neuropsychiatric disorders with moderate heritability in general. Our results may provide a new entry point for following and predicting treatment outcome, as well as prediction of severity and recurrence of MDD. In total, 33 MDD patients and 34 healthy controls were analyzed using basal gene expression in whole blood, and gene expression from whole blood that was stimulated with LPS for 5-6 h, using microarrays. Patients were arbitrarily selected from all patients to serve as primary cohort (nMDD = 21 (MDD01-MDD21); nControls = 21 (Con01-Con21)), or replication cohort (nMDD = 12 (MDD22-MDD35); nControls = 13 (Con22-Con37)) using microarrays. This submission does not include Samples CON21_LPS or CON30_LPS.