The Prevalence and National Burden of Treatment-Resistant Depression and Major Depressive Disorder in the United States

Summary & key facts

Researchers combined data from four large insurance and veteran health records and a national survey to estimate how common treatment-resistant depression is in the United States and how much it costs. They found that about 8.9 million adults were treated with medication for major depression in a year, and about 2.8 million of those people had treatment-resistant depression. That group caused a large share of the money lost to health care bills, lost work, and lower productivity. The study says better ways to manage treatment-resistant depression could bring big economic and social benefits, but the numbers come from combining different data sources and so are estimates, not exact counts.

Key facts:

• About 8.9 million adults in the United States were treated with medication for major depressive disorder in a 12-month period.
• About 2.8 million of those people, or roughly 31 percent, met the study's definition of treatment-resistant depression.
• The total estimated annual cost of medication-treated major depression in the U.S. was about 93 billion dollars.
• Treatment-resistant depression accounted for about 44 billion dollars of that total, roughly 47 percent of the overall cost.
• Treatment-resistant depression made up a larger share of health care spending than of lost work output. It was about 57 percent of the health care costs, about 48 percent of unemployment-related costs, and about 32 percent of lost productivity.
• The study combined insurance and veterans' health records with a national health survey and used a cost model, so the results are estimates based on those data sources rather than exact counts.

Abstract

OBJECTIVE: Estimates of prevalence and burden of treatment-resistant depression (TRD) vary widely in the literature. This study evaluated the prevalence and burden of TRD and the share of TRD in the burden of medication-treated major depressive disorder (MDD) using the most commonly accepted definition of TRD and a novel bottom-up approach. METHODS: Prevalence and health care burden of TRD were estimated by synthetizing inputs across 4 similarly designed claims studies in adults covered by Medicare, Medicaid, commercial plans, and the US Veterans Health Administration (VHA). Productivity (absenteeism and presenteeism) and unemployment burden were estimated based on inputs from a study conducted with data from the Kantar National Health and Wellness Survey (NHWS; 2017). A targeted literature search for additional inputs was performed. A cost model was developed to estimate the burden of TRD and medication-treated DSM-5-defined MDD in the United States. Study outcomes were the 12-month prevalence of TRD and the annual health care, productivity, and unemployment burden of TRD and medication-treated MDD in the United States. RESULTS: The estimated 12-month prevalence of medication-treated MDD in the United States was 8.9 million adults, and 2.8 million (30.9%) had TRD. The total annual burden of medication-treated MDD among the US population was $92.7 billion, with $43.8 billion (47.2%) attributable to TRD. The share of TRD was 56.6% ($25.8 billion) of the health care burden, 47.7% ($8.7 billion) of the unemployment burden, and 32.2% ($9.3 billion) of the productivity burden of medication-treated MDD. CONCLUSIONS: TRD is associated with disproportionate health care costs and unemployment, suggesting potentially large economic and societal gains with effective management.

Topics

Cardiac Health and Mental Health Mental Health Treatment and Access Treatment of Major Depression

Categories

Health Sciences Medicine Pharmacology

Tags

Depression (economics) Economics Macroeconomics Major depressive disorder Medicine Mood Psychiatry Psychology Treatment-resistant depression

Conditions & symptoms

Depression Lack of energy or motivation Poor sleep Sadness or low mood