The Prevalence and National Burden of Treatment-Resistant Depression and Major Depressive Disorder in the United States.
Level 4 - case-series / case-control
Economic cost-of-illness modeling study based on pooled retrospective claims and survey datasets
PubMed 33989464 · doi:10.4088/JCP.20m13699
What was done
The authors estimated the 12-month prevalence and economic burden of treatment-resistant depression (TRD) and its share within medication-treated major depressive disorder (MDD) in the United States. They developed a bottom-up cost model synthesizing inputs across 4 similarly designed administrative claims studies (covering Medicare, Medicaid, commercial plans, and the Veterans Health Administration) alongside productivity (absenteeism and presenteeism) and unemployment inputs from the 2017 Kantar National Health and Wellness Survey and targeted literature searches.
What was found
The estimated 12-month prevalence of medication-treated MDD in the US was 8.9 million adults, of whom 2.8 million (30.9%) had TRD. The total annual economic burden of medication-treated MDD was $92.7 billion, with $43.8 billion (47.2%) attributable to TRD. For specific components, TRD accounted for $25.8 billion (56.6%) of the health care burden, $8.7 billion (47.7%) of the unemployment burden, and $9.3 billion (32.2%) of the productivity burden.
Why it matters
These findings show that patients with TRD represent roughly one-third of the medication-treated MDD population in the US but account for nearly half of the total economic burden and over half of direct healthcare costs.
Limits
The analysis relies on an economic synthesis model pooling disparate secondary data sources (claims databases and self-reported survey data) rather than direct primary measurement. The total underlying sample size is not stated in the abstract, confidence intervals are omitted, and findings are restricted to individuals receiving pharmacological treatment for MDD.
Cited by
- contradicts Sixty percent of depression cases today are classified as treatment resistant.