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Recco K, Bonetto GG, Lupo C, Nardi AE, Morales A, Becerra-Palars C, Perocco S, Pfau A. Treatment-Resistant Depression in America Latina study: one-year follow-up of treatment resistant depression patients under standard of care reveals insights on quality of life, disability, work impairment, and depressive symptoms. Front Psychiatry 2023; 14:1221746. [PMID: 37965358 PMCID: PMC10641694 DOI: 10.3389/fpsyt.2023.1221746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 10/03/2023] [Indexed: 11/16/2023] Open
Abstract
Introduction Depressive Disorders are on the rise worldwide. This is also the case in Latin America (LatAm). Treatment-Resistant Depressive Disorder (TRD) poses additional burden to patients with depression. Impacts quality of life (QoL) and other dimensions, and standard of care (SOC) is insufficient to achieve the desired clinical outcomes. Evidence from LatAm is, however, lacking. The present study was devised as a 1-year follow-up of the SOC in TRD patients in LatAm to explore the burden of TRD. Methods This was an observational, multinational, longitudinal study. Patients with clinical diagnosis of TRD in LatAm were included in a 1-year follow-up with SOC. Beyond the Sociodemographic characterization, outcome measures were QoL (EQ-5D-5L), disability (Sheehan Disability Scale - SDS), work productivity (Work Productivity and Activity Incapacity Questionnaire: depression - WPAI:D) and depression severity (Patient Health Questionnaire-PHQ9). Patients were assessed every 3-months and comparison was performed based on change from baseline to each visit and end of study (EOS - 12 months). Results Patients averaged 48 (± 13.12) years, mostly female (80.9%) and married/consensual union (42.5%) or single patients (34.4%). Despite the SOC treatment, three-quarters of the patients remained symptomatic at EOS, regardless of the significant longitudinal decrease (p ≤ 0.001). Similar trends were found for disability (p ≤ 0.001) -82.2% of the patients reporting work/school disruption at EOS-, percentage of work (34%) and activity impairment (40%) at EOS (p ≤ 0.001) and only 29.2% of patients with depressive severity "none" at EOS (p ≤ 0.001). The results portray the need to improve clinical outcomes in this complex and burdensome disease in LatAm. Discussion Here we show that the burden of TRD remains significant in essential dimensions of everyday life at EOS underlining the need for better therapeutic solutions. The improvements in most patients do not provide the desired outcome of return to the state before the condition. Further research should focus on identifying which treatments provide better outcomes in a real-world context.
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Affiliation(s)
- Kelen Recco
- Instituto de Neurociências Dr João Quevedo, Criciúma, Santa Catarina, Brazil
| | | | - Christian Lupo
- Centro de Investigación y Asistencia en Psiquiatria, Rosario, Argentina
| | - Antonio E. Nardi
- Outpatient Clinic for Resistant Depression, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Arnulfo Morales
- Instituto de Seguridad Social del Estado de México y Municipios, Toluca, Mexico
| | | | | | - Alanna Pfau
- Janssen, Pharmaceutical Companies, Titusville, NJ, United States
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Fu DJ, Zhang Q, Shi L, Borentain S, Guo S, Mathews M, Anjo J, Nash AI, O'Hara M, Canuso CM. Esketamine versus placebo on time to remission in major depressive disorder with acute suicidality. BMC Psychiatry 2023; 23:587. [PMID: 37568081 PMCID: PMC10416356 DOI: 10.1186/s12888-023-05017-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 07/10/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Esketamine (ESK) nasal spray, taken with oral antidepressant therapy, is approved for the treatment of depressive symptoms in adults with major depressive disorder (MDD) with acute suicidal ideation or behavior. In pooled analyses of two pivotal phase 3 studies, ASPIRE I and II, remission rates were consistently higher among patients with MDD with active suicidality who were treated with ESK + standard of care (SOC) versus placebo (PBO) + SOC at all time points in the double-blind and most time points in the follow-up phases. The current analysis of the ASPIRE data sets assessed the effect of ESK + SOC versus PBO + SOC on additional remission-related endpoints: time to achieving remission and consistent remission, proportion of patients in remission and consistent remission, and days in remission. METHODS Post hoc analysis of pooled data from ASPIRE I and II (N = 451). Remission and consistent remission were defined as Montgomery-Åsberg Depression Rating Scale (MADRS) total score ≤ 12 at any given visit or two consecutive visits, respectively. Combined endpoints utilizing Clinical Global Impression-Severity of Suicidality-revised version [CGI-SS-r] ≤ 1 (i.e., not suicidal/questionably suicidal) along with the remission and consistent remission definitions (i.e., MADRS total score ≤ 12) were also examined. RESULTS The median times to remission and consistent remission of MDD were significantly shorter in ESK + SOC versus PBO + SOC (15 versus 23 [p = 0.005] and 23 versus 50 days [p = 0.007], respectively) and a greater proportion of patients in ESK + SOC achieved remission and consistent remission by Day 25 (65.2% versus 55.5% and 54.2% versus 39.8%, respectively). Similar results were obtained using the combined endpoint for both remission definitions. The median percent of days in remission during the double-blind treatment phase was significantly greater in ESK + SOC (27.1% or 5 days) versus PBO + SOC (8.3% or 2 days; p = 0.006), and the significant difference was maintained during follow-up. CONCLUSION Treatment with ESK + SOC versus PBO + SOC resulted in significantly shorter time to remission, greater proportion of patients in remission, and greater percent of days in remission using increasingly rigorous definitions of remission. These findings underscore the clinical benefits of ESK for adults with MDD with suicidality. TRIAL REGISTRATION ClinicalTrials.gov registry NCT03039192 (registered February 1, 2017) and NCT03097133 (registered March 31, 2017).
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Affiliation(s)
- Dong-Jing Fu
- Janssen Research & Development, LLC, Titusville, NJ, 08560, USA.
| | - Qiaoyi Zhang
- Janssen Global Services, LLC, Titusville, NJ, 08560, USA
| | - Ling Shi
- Evidera-PPD, Bethesda, MD, 20814, USA
| | | | - Shien Guo
- Evidera-PPD, Bethesda, MD, 20814, USA
| | - Maju Mathews
- Janssen Global Services, LLC, Titusville, NJ, 08560, USA
| | - Joana Anjo
- Janssen Cilag-Farmacêutica, 2740-262, Porto Salvo, Portugal
| | - Abigail I Nash
- Janssen Scientific Affairs, LLC, Titusville, NJ, 08560, USA
| | | | - Carla M Canuso
- Janssen Research & Development, LLC, Titusville, NJ, 08560, USA
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Caldieraro MA, Tung TC, Agudelo Baena LM, Vilapriño Duprat M, Corral RM, Alviso de la Serna LD, Saucedo E, Kanevsky G, Cabrera P. Depression and suicidality severity among TRD patients after 1-year under standard of care: Findings from the TRAL study, a multicenter, multinational, observational study in Latin America. SPANISH JOURNAL OF PSYCHIATRY AND MENTAL HEALTH 2023; 16:85-94. [PMID: 38591721 DOI: 10.1016/j.rpsm.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Treatment resistant depression (TRD) is one of the most pressing issues in mental healthcare in LatAm. However, clinical data and outcomes of standard of care (SOC) are scarce. The present study reported on the Treatment-Resistant Depression in America Latina (TRAL) project 1-year follow-up of patients under SOC assessing clinical presentation and outcomes. MATERIALS AND METHODS 420 patients with clinical diagnoses of TRD from Argentina, Brazil, Colombia and Mexico were included in a 1-year follow-up to assess clinical outcomes of depression (MADRS) and suicidality (C-SSRS), as well as evolution of clinical symptoms of depression. Patients were assessed every 3 months and longitudinal comparison was performed based on change from baseline to each visit and end of study (12 months). Socio demographic characterization was also performed. RESULTS Most patients were female (80.9%), married (42.5%) or single (34.4%), with at least 10 years of formal education (71%). MDD diagnosis was set at 37.29 (SD=14.00) years, and MDD duration was 11.11 years (SD=10.34). After 1-year of SOC, 79.1% of the patients were still symptomatic, and 40% of the patients displayed moderate/severe depression. Only 44.1% of the patients achieved a response (≥50% improvement in MADRS), and 60% of the sample failed to achieve remission. Suicidal ideation was reported by more than half of the patients at the end of study. CONCLUSIONS Depression and suicidality symptoms after a 1-year of SOC is of great concern. Better therapeutic options are needed to tackle this debilitating and burdensome disease.
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Affiliation(s)
- Marco Antonio Caldieraro
- Programa de Pós-Graduação em Psiquiatria e Ciências do Comportamento, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Serviço de Psiquiatria, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Teng Chei Tung
- Departamento de Psiquiatria, Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | | | - Manuel Vilapriño Duprat
- Médico Psiquiatra, Centro de Estudios Asistencia e Investigación en Neurociencias (CESASIN), Mendoza, Argentina
| | - Ricardo Marcelo Corral
- Médico especialista en Psiquiatría; Presidente Fundación Estudio y Tratamiento de las Enfermedades Mentales, Buenos Aires, Argentina
| | | | - Erasmo Saucedo
- Departamento de Psiquiatría del Hospital Universitario de la Universidad Autónoma de Nuevo León/CIT-Neuropsique S.C (Centro de Investigación y Terapia), Argentina
| | - Gabriela Kanevsky
- Janssen-Cilag Farmacéutica (Argentina), Mendoza, Buenos Aires, Argentina.
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Sun J, Luo Y, Ma Y, Guo C, Du Z, Gao S, Chen L, Wang Z, Li X, Xu K, Hong Y, Yu X, Xiao X, Fang J. Sex Differences of the Functional Brain Activity in Treatment-Resistant Depression: A Resting-State Functional Magnetic Resonance Study. Brain Sci 2022; 12:brainsci12121604. [PMID: 36552064 PMCID: PMC9775169 DOI: 10.3390/brainsci12121604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/16/2022] [Accepted: 11/19/2022] [Indexed: 11/24/2022] Open
Abstract
The presence of different clinical symptoms in patients with treatment-resistant depression (TRD) of different sexes may be related to different neuropathological mechanisms. A total of 16 male patients with TRD, 18 female patients with TRD, 18 male healthy controls (HCs) and 19 female HCs completed this study. We used the amplitude of low frequency fluctuations (ALFF) method to analyze the results. Moreover, the correlation between abnormal brain areas and clinical symptoms in different sexes of the TRD groups was also analyzed. The effects of the sex-by-group interaction difference in ALFF among the four groups was located in the left middle frontal gyrus, left precentral gyrus and left precuneus. Post hoc comparisons revealed that the male TRD group had lower ALFF in the left middle frontal gyrus and left precentral gyrus compared with the female TRD group. There was a positive correlation between the left middle frontal gyrus, the left precuneus and the 17-item Hamilton Rating Scale for Depression scale (HAMD-17) scores, and a negative correlation between the left precentral gyrus and the HAMD-17 scores in the female TRD group. This study will provide some clinical reference value for the sex differences in neuropathological mechanisms of TRD.
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Affiliation(s)
- Jifei Sun
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Yi Luo
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Yue Ma
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Chunlei Guo
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Zhongming Du
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
| | - Shanshan Gao
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Limei Chen
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Zhi Wang
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Xiaojiao Li
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Ke Xu
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Yang Hong
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
| | - Xue Yu
- Beijing First Hospital of Integrated Chinese and Western Medicine, Beijing 100026, China
| | - Xue Xiao
- Beijing First Hospital of Integrated Chinese and Western Medicine, Beijing 100026, China
| | - Jiliang Fang
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China
- Correspondence: ; Tel.: +010-88001493
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Zhdanava M, Karkare S, Pilon D, Joshi K, Rossi C, Morrison L, Sheehan J, Lefebvre P, Lopena O, Citrome L. Prevalence of Pre-existing Conditions Relevant for Adverse Events and Potential Drug-Drug Interactions Associated with Augmentation Therapies Among Patients with Treatment-Resistant Depression. Adv Ther 2021; 38:4900-4916. [PMID: 34368919 PMCID: PMC8408057 DOI: 10.1007/s12325-021-01862-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/13/2021] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Pre-existing conditions relevant for adverse events (AE) and the potential for drug-drug interactions (DDIs) may limit safe pharmacotherapeutic augmentation options for patients with major depressive disorder (MDD). This concern may be heightened among patients with treatment-resistant depression (TRD), who often have comorbid medical disorders. METHODS Adults with MDD and ≥ 1 antidepressant claim within the first observed major depressive episode were identified in the MarketScan® Databases. Those initiating a new regimen after two regimens at adequate dose and duration were considered to have TRD. The index date was defined at TRD onset or on a random antidepressant claim among patients with non-TRD MDD. Pre-existing conditions 12 months pre-index and potential DDIs 3 months pre/post-index associated with specific non-antidepressant augmentation therapies, including atypical antipsychotics (APs), buspirone, psychostimulants, anticonvulsants, thyroid hormone, and lithium were compared between 1:1 matched TRD and non-TRD MDD cohorts. RESULTS Overall, 3414 patients with TRD and non-TRD MDD (mean age 39.7 years, 69% female) were matched. Relative to non-TRD MDD, patients with TRD had 33% higher likelihood of ≥ 1 pre-existing condition relevant for AEs listed in product labels of non-antidepressant augmentation therapies (p < 0.001). Patients with TRD vs. non-TRD MDD had 12.9 and 6.4 times higher likelihood of ≥ 2 and ≥ 3 DDIs, respectively, based on their medication regimen (all p < 0.001). CONCLUSION Pre-existing conditions relevant for listed AEs and potential DDIs limit safe augmentation options in MDD, particularly among patients with TRD. Payer prior authorization policies requiring several augmentation therapy trials to access novel treatments may complicate clinical management of this population.
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Affiliation(s)
- Maryia Zhdanava
- Analysis Group, Inc, 1190 avenue des Canadiens-de-Montréal, Deloitte Tower, Suite 1500, Montreal, QC, H3B 0G7, Canada.
| | - Swapna Karkare
- Real-World Value and Evidence, Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | - Dominic Pilon
- Analysis Group, Inc, 1190 avenue des Canadiens-de-Montréal, Deloitte Tower, Suite 1500, Montreal, QC, H3B 0G7, Canada
| | - Kruti Joshi
- Real-World Value and Evidence, Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | - Carmine Rossi
- Analysis Group, Inc, 1190 avenue des Canadiens-de-Montréal, Deloitte Tower, Suite 1500, Montreal, QC, H3B 0G7, Canada
| | - Laura Morrison
- Analysis Group, Inc, 1190 avenue des Canadiens-de-Montréal, Deloitte Tower, Suite 1500, Montreal, QC, H3B 0G7, Canada
| | - John Sheehan
- Real-World Value and Evidence, Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | - Patrick Lefebvre
- Analysis Group, Inc, 1190 avenue des Canadiens-de-Montréal, Deloitte Tower, Suite 1500, Montreal, QC, H3B 0G7, Canada
| | - Oliver Lopena
- Real-World Value and Evidence, Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | - Leslie Citrome
- Department of Psychiatry and Behavioral Sciences, New York Medical College, Valhalla, NY, USA
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Voelker J, Joshi K, Daly E, Papademetriou E, Rotter D, Sheehan JJ, Kuvadia H, Liu X, Dasgupta A, Potluri R. How well do clinical and demographic characteristics predict Patient Health Questionnaire-9 scores among patients with treatment-resistant major depressive disorder in a real-world setting? Brain Behav 2021; 11:e02000. [PMID: 33403828 PMCID: PMC7882175 DOI: 10.1002/brb3.2000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/06/2020] [Accepted: 11/18/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To create and validate a model to predict depression symptom severity among patients with treatment-resistant depression (TRD) using commonly recorded variables within medical claims databases. METHODS Adults with TRD (here defined as > 2 antidepressant treatments in an episode, suggestive of nonresponse) and ≥ 1 Patient Health Questionnaire (PHQ)-9 record on or after the index TRD date were identified (2013-2018) in Decision Resource Group's Real World Data Repository, which links an electronic health record database to a medical claims database. A total of 116 clinical/demographic variables were utilized as predictors of the study outcome of depression symptom severity, which was measured by PHQ-9 total score category (score: 0-9 = none to mild, 10-14 = moderate, 15-27 = moderately severe to severe). A random forest approach was applied to develop and validate the predictive model. RESULTS Among 5,356 PHQ-9 scores in the study population, the mean (standard deviation) PHQ-9 score was 10.1 (7.2). The model yielded an accuracy of 62.7%. For each predicted depression symptom severity category, the mean observed scores (8.0, 12.2, and 16.2) fell within the appropriate range. CONCLUSIONS While there is room for improvement in its accuracy, the use of a machine learning tool that predicts depression symptom severity of patients with TRD can potentially have wide population-level applications. Healthcare systems and payers can build upon this groundwork and use the variables identified and the predictive modeling approach to create an algorithm specific to their population.
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Affiliation(s)
| | - Kruti Joshi
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | - Ella Daly
- Janssen Research & Development, LLC, Titusville, NJ, USA
| | | | | | | | | | - Xing Liu
- SmartAnalyst, Inc, New York, NY, USA
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Zhdanava M, Kuvadia H, Joshi K, Daly E, Pilon D, Rossi C, Morrison L, Lefebvre P, Nelson C. Economic burden of treatment-resistant depression in privately insured US patients with co-occurring anxiety disorder and/or substance use disorder. Curr Med Res Opin 2021; 37:123-133. [PMID: 33124940 DOI: 10.1080/03007995.2020.1844645] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To assess the burden of treatment-resistant depression (TRD) among privately insured patients with anxiety disorder and/or substance use disorders (SUD). METHODS Adults <65 years old were identified in the Optum Health Care Solutions Inc. database (July 2009-March 2017). Among those with major depressive disorder (MDD) and antidepressant use, patients who initiated a third antidepressant (index date) after two regimens at adequate dose and duration were classified in the TRD cohort and patients without evidence of TRD were classified in the non-TRD MDD control cohort. The non-MDD control cohort comprised patients without MDD. In the non-TRD MDD and non-MDD cohorts, the index date was imputed to mimic the distribution of time in the TRD cohort from the first antidepressant to the index date or from the start of eligibility to the index date, respectively. Patients with <6 months of continuous insurance eligibility pre-/post-index, psychosis, schizophrenia, bipolar disorder and related conditions, dementia, and development disorders, and/or no baseline anxiety disorder and/or SUD were excluded. Patients with TRD were matched 1:1 to patients with non-TRD MDD and patients without MDD, based on exact matching factors (i.e. availability of work loss data) and propensity scores computed based on characteristics measured pre-index. Outcomes, including healthcare resource use (HRU) and costs, work productivity loss and related costs measured per patient per year ≤24 months post-index were compared between matched TRD, non-TRD MDD and non-MDD cohorts. RESULTS A total of 3166 patients were identified in the TRD cohort and matched to non-TRD MDD and non-MDD cohorts. Among patients with TRD (mean age 39 years, 60.5% female), 87.3% had an anxiety disorder, 24.1% had SUD. The TRD cohort had higher HRU vs non-TRD MDD and non-MDD cohorts: 0.32 vs 0.20 and 0.14 inpatient admissions, 0.91 vs 0.73 and 0.58 emergency department visits, and 23.8 vs 16.8 and 11.6 outpatient visits, respectively (all p < .01). The TRD cohort had higher healthcare costs ($16,674) vs non-TRD MDD ($10,945) and non-MDD ($6493) cohorts (all p < .01). Among patients with work loss data (N = 310/cohort), patients with TRD had more work loss days (54) and higher work loss-related costs ($13,674) vs patients with non-TRD MDD (32 days; $7131) and without MDD (17 days; $4798; all p < .01). CONCLUSIONS In patients with an anxiety disorder and/or SUD, TRD was associated with higher HRU, healthcare costs, work loss days and work loss-related costs.
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Affiliation(s)
| | | | - Kruti Joshi
- Janssen Scientific Affairs LLC, Titusville, NJ, USA
| | - Ella Daly
- Janssen Scientific Affairs LLC, Titusville, NJ, USA
| | | | | | | | | | - Craig Nelson
- Department of Psychiatry, University of California, San Francisco, CA, USA
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Benson C, Singer D, Carpinella CM, Shawi M, Alphs L. The Health-Related Quality of Life, Work Productivity, Healthcare Resource Utilization, and Economic Burden Associated with Levels of Suicidal Ideation Among Patients Self-Reporting Moderately Severe or Severe Major Depressive Disorder in a National Survey. Neuropsychiatr Dis Treat 2021; 17:111-123. [PMID: 33500620 PMCID: PMC7822234 DOI: 10.2147/ndt.s229530] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 12/22/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Suicidal ideation (SI) is a cardinal aspect of major depressive disorder (MDD); however, patient-reported outcomes data from large-scale surveys are limited concerning SI in the context of MDD. This study aims to understand the association between varying levels of SI and health-related quality of life (HRQoL), work productivity, healthcare resource utilization (HRU), and associated costs in patients with moderately severe/severe MDD. METHODS This was a retrospective, cross-sectional analysis of 2013 national survey data. Patients who self-reported moderately severe or severe MDD and completed the Short Form Survey Version 2 (SF-36v2), Work Productivity Loss and Activity Impairment questionnaire (WPAI), and questions related to HRU were analyzed. Direct and indirect costs were calculated. Patients were categorized and analyzed by the level of SI (no SI, low, moderate, and high) based on their response to Item 9 of the Patient Health Questionnaire-9. RESULTS Among 75,000 respondents, 15.3% self-reported receiving a physician diagnosis of moderately severe or severe MDD and 2.8% of the total sample endorsed some level of SI. Patients with high SI showed a higher burden than patients with no SI, reporting lower mean SF-36v2 mental component summary scores (p<0.001), higher work productivity loss (p=0.039), and higher numbers of per patient per month hospitalizations (p=0.002) and emergency room visits (p=0.011). High SI was associated with greater per patient per month direct costs ($1220 vs $796; p=0.002) and indirect costs ($1449 vs $1058; p=0.001) compared with no SI. When patients with low or moderate SI were compared with patients with no SI, the results were mixed. CONCLUSION Higher levels of SI were associated with lower HRQoL, greater HRU, and more work impairment resulting in higher direct and indirect costs compared with patients with MDD but no SI. These results highlight the need to implement effective treatment models and interventions in the employed population.
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Affiliation(s)
- Carmela Benson
- Real-World Value & Evidence, Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | - David Singer
- Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - May Shawi
- Neuroscience Medical Affairs, Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | - Larry Alphs
- Neuroscience Medical Affairs, Janssen Scientific Affairs, LLC, Titusville, NJ, USA
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McIntyre RS, Millson B, Power GS. Burden of Treatment Resistant Depression (TRD) in patients with major depressive disorder in Ontario using Institute for Clinical Evaluative Sciences (ICES) databases: Economic burden and healthcare resource utilization. J Affect Disord 2020; 277:30-38. [PMID: 32791390 DOI: 10.1016/j.jad.2020.07.045] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 06/04/2020] [Accepted: 07/05/2020] [Indexed: 01/07/2023]
Abstract
INTRODUCTION The burden of treatment-resistant depression (TRD) in Canada requires empirical characterization to better inform clinicians and policy decision-making in mental health. Towards this aim, this study utilized the Institute for Clinical Evaluative Sciences (ICES) databases to quantify the economic burden and resource utilization of Patients with TRD in Ontario. METHODS TRD, Non-TRD Major Depressive Disorder (Non-TRD MDD) and Non-MDD cohorts were selected from the ICES databases between April 2006-March 2015 and followed-up for at least two years. TRD was defined as a minimum of two treatment failures within one-year of the index MDD diagnosis. Non-TRD and Non-MDD patients were matched with patients with TRD to analyze costs, resource utilization, and demographic information. RESULTS Out of 277 patients with TRD identified, the average age was 52 years (SD 16) and 53% were female. Compared to Non-TRD, the patients with TRD had more all-cause visits to outpatient (38.2 vs. 24.2) and emergency units (2.7 vs. 2.0) and more depression-related visits to GPs (3.06 vs. 1.63) and psychiatrists (5.88 vs. 1.95) (all p < 0.05). The average two-year cost for TRD patients was $20,998 (CAD). LIMITATIONS This study included patients with only public plan coverage; therefore, overall TRD population and cash and private claims were not captured. CONCLUSIONS Patients with TRD exhibit a significantly higher demand on healthcare resources and higher overall payments compared to Non-TRD patients. The findings suggest that there are current challenges in adequately managing this difficult-to-treat patient group and there remains a high unmet need for new therapies.
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Affiliation(s)
- Roger S McIntyre
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of Pharmacology, University of Toronto, Toronto, ON, Canada; Mood Disorders Psychopharmacology Unit, University Health Network, 399 Bathurst Street, Toronto M5T2S8, ON, Canada.
| | - Brad Millson
- IQVIA, Health Access and Outcomes, Kirkland, Quebec, Canada
| | - G Sarah Power
- IQVIA, Health Access and Outcomes, Kirkland, Quebec, Canada
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Pilon D, Szukis H, Singer D, Morrison L, Sheehan JJ, Lefebvre P. Use of home health and other healthcare delivery pathways among privately insured patients with and without treatment-resistant depression. Curr Med Res Opin 2020; 36:865-874. [PMID: 31985319 DOI: 10.1080/03007995.2020.1722081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: To assess the real-world use of home health services (HHS) among patients with major depressive disorder (MDD) with and without treatment-resistant depression (TRD).Methods: Adults (18-64 years) from a commercial claims database (07/2009 to 03/2015) were categorized into three cohorts: "TRD"(N = 6411), "non-TRD MDD"(N = 33,068), "non-MDD"(N = 149,884) stratified based on use of HHS (HHS vs. no-HHS). Healthcare resource utilization (HRU) and costs were evaluated up to two years following the first antidepressant pharmacy claim using descriptive statistics. HRU (e.g. inpatient, outpatient, emergency department visits) and costs were measured per-patient-per-year (PPPY) in 2015 USD.Results: During the follow-up period, 18.0% of TRD, 12.4% of non-TRD MDD, and 6.5% of non-MDD patients received HHS. Mean all-cause healthcare costs PPPY were numerically higher among patients with HHS use. Among the TRD cohort, patients using HHS had healthcare costs of $40,040 PPPY while patients with TRD and no-HHS had healthcare costs of $12,272 PPPY. Within the non-TRD MDD cohort, HHS users incurred healthcare costs of $28,767 PPPY and non-HHS users incurred costs of $7227 PPPY. Patients without MDD who used HHS had annual healthcare costs of $22,340 while non-MDD patients who did not use HHS had healthcare costs of $3479 PPPY. However, among HHS users, HHS costs represented a relatively small proportion of total healthcare costs.Conclusions: The high proportion of TRD patients using HHS suggests it is a utilized healthcare delivery pathway by TRD patients.
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Affiliation(s)
| | - Holly Szukis
- Janssen Scientific Affairs, LLC, Titusville, NJ, USA
| | - David Singer
- Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, PA, USA
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