BACKGROUND: Difficult-to-treat (DTT) depression includes patients who are less likely to respond to conventional antidepressant therapy due to treatment- resistant depression (TRD), bipolar depression, and/or psychotic depression. Recent evidence indicates that patients with TRD utilize more health care services than non-TRD patients. However, little is known about the health care costs associated with DTT depression.
OBJECTIVE: To identify DTT depressed patients—including those diagnosed with psychotic depression, bipolar depression or patients identified as likely to have TRD—and provide a descriptive analysis—including demographics and patterns of medical care utilization for DTT depressed patients and non-DTT depressed patients.
METHODS: We identified patients with a claim for the diagnosis of major depressive disorder (ICD-9 codes 296, 309, or 311) between January 1, 1996 and December 31, 1998 (N=36,611) using the Saskatchewan Health databases. After excluding patients with comorbid psychosis, patients whose depression was untreated, and patients who were less severely depressed, treatment algorithms were applied to classify depressed patients as DTT and non-DTT. Demographics, resource utilization, and costs were compared between the two groups.
RESULTS: We identified 1,825 (13%) DTT depressed patients. DTT depressed patients had significantly higher annualized costs and resource utilization than non-DTT depressed patients for all measured outcomes. The median annualized costs per patient for hospital, physician, and prescription services were CAD$2,073 for DTT depressed patients and CAD$1,005 for non-DTT depressed patients. The median number of medical claims per patient for the first year of follow-up was 56 for DTT and 32 for non-DTT depressed patients. DTT depressed patients had significantly more physician visits and hospitalizations and a longer median length of stay (4.5 vs. 3 days).
CONCLUSION: DTT depressed patients consume significantly more medical resources and have higher medical costs associated with their treatment than non-DTT depressed patients. Successful treatment of DTT depression may reduce treatment costs and medical resource consumption.
