Direct and Indirect Cost Burden and Change of Employment Status in Treatment-Resistant Depression: A Matched-Cohort Study Using a US Commercial Claims Database

J Clin Psychiatry. 2018 Mar/Apr;79(2):17m11725. doi: 10.4088/JCP.17m11725.


Background: Treatment-resistant depression (TRD) poses a substantial burden to health care payers including employers, costing an estimated $29 billion-$48 billion yearly in the United States. Furthermore, variation of burden across increasing levels of resistance and the potential impact of TRD on employment status remain largely unexplored.

Objective: To evaluate health care resource utilization (HRU) and costs, work loss, indirect costs, and employment status change in TRD.

Methods: A claims-based algorithm identified adults with TRD from a US claims database of privately insured employees and dependents (January 2010-March 2015). TRD patients were matched 1:1 on demographics to patients with major depressive disorder (MDD) (non-TRD MDD) and without MDD (non-MDD), who were identified using ICD-9-CM codes. Costs, HRU, and employment status change were compared over 2 years following the first antidepressant (randomly imputed date for non-MDD), adjusting for baseline comorbidity index and costs.

Results: TRD patients (N = 6,411) had more HRU than either matched control cohort, translating into higher per patient per year (PPPY) health care costs: $6,709 and $9,917 more than non-TRD MDD and non-MDD patients, respectively (P < .001 for both). TRD patients with work loss data (N = 1,908) had 35.8 work loss days PPPY (1.7 and 6.2 times the work loss rate in non-TRD MDD and non-MDD patients, respectively). Work loss-related costs in TRD patients were $1,811 higher than non-TRD MDD and $3,460 higher than in non-MDD patients (P < .001). TRD patients had 1.3-1.4 times the rate of employment status change versus control cohorts (all P < .05).

Conclusions: TRD, even compared to MDD, poses a significant direct and indirect cost burden to US employers and may be associated with higher rates of employment status change.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cohort Studies
  • Cost of Illness*
  • Databases, Factual / statistics & numerical data
  • Depressive Disorder, Major* / diagnosis
  • Depressive Disorder, Major* / economics
  • Depressive Disorder, Major* / epidemiology
  • Depressive Disorder, Treatment-Resistant* / diagnosis
  • Depressive Disorder, Treatment-Resistant* / economics
  • Depressive Disorder, Treatment-Resistant* / epidemiology
  • Employment / statistics & numerical data*
  • Female
  • Health Care Costs
  • Humans
  • Insurance Claim Review / statistics & numerical data
  • International Classification of Diseases
  • Male
  • Matched-Pair Analysis
  • Middle Aged
  • Retrospective Studies
  • United States / epidemiology