A patient with treatment-resistant depression (TRD) costs Medicare 21%, or $8,000, more annually than a patient with depression that is controlled.
So finds a new report from Health Management Associates (HMA), a health policy consulting firm. The report aimed to quantify the direct economic impact of the condition, looking at Medicare claims data from 2022 and 2023 for its analysis.
The firm identified major depressive disorder claims that included at least one inpatient encounter or at least two hospital outpatient claims within a year. TRD was defined as patients who underwent two or more antidepressant therapy changes.
About a third of the 34 million American teens and adults who have depression have TRD, the analysis found. Existing literature suggests the annual national burden of TRD is between $29 and $48 billion, representing up to 41% of total depression costs, the report said.
In general, if found, TRD is associated with higher healthcare utilization and greater productivity loss compared with depression that is controlled.
“This is a really big economic burden that’s happening,” Mark Desmarais, HMA principal and co-author of the report, told Fierce Healthcare. The report did not analyze indirect costs, including those related to unpaid caregivers. “It’s a hidden cost that the system bears, and one that’s harder to quantify.”
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The report found that TRD patients cost Medicare about $46,000 annually, with the majority of costs attributable to hospitalizations and prescription costs. Compared to patients with depression, TRD patients incurred greater inpatient spending and higher outpatient costs, suggesting more intensive and frequent use of acute and ambulatory services. Physician spending also increased among TRD patients, indicating greater reliance on clinician visits and ongoing management, per the report.
“This may be an issue that isn’t getting as much attention as it deserves, based on what we’re finding,” Desmarais said.
The challenging nature of TRD is that, by definition, it is difficult to treat. Existing interventions like transcranial magnetic stimulation (TMS) and electroconvulsive therapy (ECT) that help manage symptoms and require repeated engagement are not cheap. The analysis found that TRD patients undergoing TMS cost nearly $29,000 more compared to patients with controlled depression; those undergoing ECT cost $48,000 more. “We’re talking about much higher figures,” Desmarais said.
Desmarais believes the data analyzed was far enough removed from the height of the COVID-19 pandemic to not be skewed by it. To look at trends over time, HMA would have to wait at least one more year, or ideally two years, to be able to do another analysis. No specific plans for a follow-up report are in place at this time.
“Sometimes you have to put it in economic terms to get everyone to pay attention to the fact that there’s a human element here that’s being underserved,” Desmarais said. He added HMA hopes the report “leads policymakers, and clinicians, and researchers, to also do the work that will lead to positive outcomes in this clinical area.”
The consulting firm called out the need for innovative, effective solutions to TRD, and stopped short of proposing specific policy recommendations. “Scalable and long-lasting interventions that improve both symptoms and daily functioning could be especially suitable for tackling TRD,” the report said.