Economic, clinical, and humanistic burden associated with major depressive disorder with prominent anhedonia in the United States: analysis of Medical Expenditure Panel Survey

Abstract

Background: Anhedonia is a core symptom of major depressive disorder (MDD). However, the burden of prominent anhedonia in patients with MDD is poorly understood.

Methods: In this cross-sectional study, adults (≥18 years) with and without MDD were identified from the Medical Expenditure Panel Survey (2016-2019). Patients with MDD were classified based on the level of anhedonia, identified using the first item of the Patient Health Questionnaire (PHQ)-2, as prominent (MDD-ANH) or other-MDD. The MDD-ANH, other-MDD, and non-MDD cohorts were propensity-score weighted based on baseline characteristics. Use of healthcare services, costs, lost productivity, and health-related quality of life (HRQoL) were compared across cohorts.

Results: A total of 5112 respondents with MDD had a valid response for anhedonia per the first item of PHQ-2 (MDD-ANH, n = 1075; other-MDD, n = 4037); 75,502 respondents were identified as non-MDD. Psychotropic polypharmacy was higher in respondents with MDD-ANH than those with other-MDD (43.2 % vs. 27.8 %; p = 0.01). Respondents with MDD-ANH had higher mean office/outpatient and emergency department visits than other-MDD and non-MDD (all p < 0.01). Mean total all-cause healthcare costs were higher in MDD-ANH ($10,353) than other-MDD ($7489) and non-MDD ($5381) (all p < 0.01). HRQoL was lower among respondents with MDD-ANH than those with other-MDD and non-MDD (all p < 0.01).

Conclusion: These findings suggest a substantial unmet need in patients with MDD-ANH. Treatments that specifically target anhedonia are needed to improve clinical outcomes, quality of life and reduce economic burden in patients with MDD.

Keywords: Anhedonia; Costs; Health-related quality of life; Healthcare services; Major depressive disorder; Polypharmacy; Treatments.