Economic Burden of Treatment-Resistant Depression Among Patients Hospitalized for Major Depressive Disorder in the United States

Jay Lin; Holly Szukis; John J Sheehan; Larry Alphs; Brandy Menges; Melissa Lingohr-Smith; Carmela Benson

doi:10.1176/appi.prcp.20190001

Economic Burden of Treatment-Resistant Depression Among Patients Hospitalized for Major Depressive Disorder in the United States

Psychiatr Res Clin Pract. 2019 Oct 11;1(2):68-76. doi: 10.1176/appi.prcp.20190001. eCollection 2019 Oct.

Authors

Jay Lin¹, Holly Szukis², John J Sheehan², Larry Alphs², Brandy Menges¹, Melissa Lingohr-Smith¹, Carmela Benson²

Affiliations

¹ Novosys Health Green Brook New Jersey.
² Janssen Scientific Affairs Titusville New Jersey.

Abstract

Objectives: This study aimed to evaluate hospital length of stay (LOS) and cost as well as readmission risk and the associated economic burden among patients hospitalized for treatment-resistant and non-treatment-resistant major depressive disorder.

Methods: Adult patients with a primary hospital discharge diagnosis of major depressive disorder were identified from the Premier Hospital Database (January 1, 2012-September 30, 2015). Patients were stratified into two cohorts: those whose hospital treatment was suggestive of treatment-resistant depression and those with non-treatment-resistant depression. Hospital LOS and cost during the initial admission and readmissions rates, LOS, and cost within the 6-month follow-up were compared between cohorts with a propensity score-matched sample.

Results: After matching, 45,066 patients were included in each cohort. For index hospitalizations, mean hospital LOS was longer (7.4 vs. 5.9 days, p<0.001) and mean hospital cost higher ($8,681 vs. $6,632, p<0.001) for patients with treatment-resistant depression vs. non-treatment-resistant depression. Rates for all-cause (24.4% vs. 20.0%, p<0.001), major depressive disorder-related (17.0% vs. 13.3%, p<0.001), and suicidal ideation/suicide attempt-related (12.8% vs. 9.5%, p<0.001) readmissions were higher for patients with treatment-resistant depression. Mean LOS and total hospital costs per patient for readmissions were also greater for patients with treatment-resistant depression vs. non-treatment-resistant depression. Correspondingly, the combined hospital cost (index hospitalization+all-cause readmissions) was greater for patients with treatment-resistant depression ($12,370 vs. $9,429, p<0.001).

Conclusions: Treatment-resistant depression was associated with substantial economic burden among patients hospitalized for major depressive disorder. More-effective treatment and care for this patient population may reduce the hospital burden of patients with treatment-resistant depression.

Keywords: Hospital costs; Hospital resource use; Major depressive disorder; Readmission risk; Treatment‐resistant depression.