Real-world evidence from a European cohort study of patients with treatment resistant depression: Healthcare resource utilization

K Heerlein; S De Giorgi; G Degraeve; T Frodl; W Hagedoorn; A J Oliveira-Maia; C Otte; V Perez Sola; S Rathod; G Rosso; P Sierra; A Vita; J Morrens; B Rive; S Mulhern Haughey; Y Kambarov; A H Young

doi:10.1016/j.jad.2021.11.004

Real-world evidence from a European cohort study of patients with treatment resistant depression: Healthcare resource utilization

J Affect Disord. 2022 Feb 1;298(Pt A):442-450. doi: 10.1016/j.jad.2021.11.004. Epub 2021 Nov 4.

Authors

K Heerlein¹, S De Giorgi², G Degraeve³, T Frodl⁴, W Hagedoorn⁵, A J Oliveira-Maia⁶, C Otte⁷, V Perez Sola⁸, S Rathod⁹, G Rosso¹⁰, P Sierra¹¹, A Vita¹², J Morrens¹³, B Rive¹⁴, S Mulhern Haughey¹⁵, Y Kambarov¹⁶, A H Young¹⁷

Affiliations

¹ Janssen EMEA, Neuss, Germany. Electronic address: kheerlei@its.jnj.com.
² Department of Mental Health ASL Lecce, Lecce, Italy.
³ AZ Alma General Hospital, Eeklo, Belgium; PC Dr Guislain Hospital, Ghent, Belgium.
⁴ Department of Psychiatry and Psychotherapy, Univeritätsklinikum Magdeburg, Otto von Guericke Universität Magdeburg, Magdeburg, Germany.
⁵ Practice for Psychiatry and Psychotherapy, Heerde, the Netherlands.
⁶ Champalimaud Research and Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal; NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisbon, Portugal.
⁷ Charité Universitätsmedizin, Berlin, Germany.
⁸ Department of Psychiatry, Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona IMIM Hospital del Mar Medical Research Institute, Univ Autonoma de Barcelona, CIBERSAM, Barcelona, Spain.
⁹ Research Department, Southern Health NHS Foundation Trust, Tom Rudd Unit, Southampton, United Kingdom.
¹⁰ Department of Neurosciences, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy.
¹¹ University and Polytechnic Hospital La Fe, University of Valencia, Valencia, Spain.
¹² Department of Mental Health and Addiction Services, Spedali Civili Hospital and University of Brescia, Brescia, Italy.
¹³ Janssen EMEA, Beerse, Belgium.
¹⁴ Janssen EMEA, Paris, France.
¹⁵ Janssen EMEA, Dublin, Ireland.
¹⁶ Janssen EMEA, Almaty, Kazakhstan.
¹⁷ Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, United Kingdom.

PMID: 34742998
DOI: 10.1016/j.jad.2021.11.004

Abstract

Background: Treatment resistant depression (TRD) is diagnosed when patients experiencing a major depressive episode fail to respond to ≥2 treatments. Along with substantial indirect costs, patients with TRD have higher healthcare resource utilization (HCRU) than other patients with depression. However, research on the economic impact of this HCRU, and differences according to response to treatment, is lacking.

Methods: This multicenter, observational study documented HCRU among patients with TRD in European clinical practice initiating new antidepressant treatments. Data regarding access to outpatient consultations and other healthcare resources for the first 6 months, collected using a questionnaire, were analyzed qualitatively according to response and remission status. The economic impact of HCRU, estimated using European costing data, was analyzed quantitatively.

Results: Among 411 patients, average HCRU was higher in non-responders, attending five times more general practitioner (GP) consultations and spending longer in hospital (1.7 versus 1.1 days) than responders. Greater differences were observed according to remission status, with non-remitters attending seven times more GP consultations and spending approximately three times longer in hospital (1.7 versus 0.6 days) than remitters. Consequently, the estimated economic impacts of non-responders and non-remitters were significantly greater than those of responders and remitters, respectively.

Limitations: Key limitations are small cohort size, absence of control groups and generalizability to different healthcare systems.

Conclusion: Patients with TRD, particularly those not achieving remission, have considerable HCRU, with associated economic impact. The costs of unmet TRD treatment needs are thus substantial, and treatment success is fundamental to reduce individual needs and societal costs.

Keywords: Healthcare resource utilization; Major depressive disorder; Observational study; Real-world evidence; Treatment resistant depression.

Publication types

Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Cohort Studies
Delivery of Health Care
Depressive Disorder, Major* / drug therapy
Depressive Disorder, Treatment-Resistant* / drug therapy
Health Care Costs
Humans
Retrospective Studies