Depressive Relapse and Increased Cost/Health Care Utilization: New Study in BMC Psychiatry

Out on PubMed, from US authors in Pharma, is this study:

Incremental burden of relapse in patients with major depressive disorder: a real-world, retrospective cohort study using claims data.

Touya M, Lawrence DF, Kangethe A, Chrones L, Evangelatos T, Polson M.BMC Psychiatry. 2022 Mar 1;22(1):152. doi: 10.1186/s12888-022-03793-7.PMID: 35232411

The abstract is copied below:

Background: Relapse is common in major depressive disorder (MDD). In this study, we evaluated the incremental health care burden of relapse in patients with MDD.

Methods: This real-world retrospective cohort study used administrative medical and pharmacy claims data to identify commercially insured adult patients in the United States diagnosed with MDD who initiated a new antidepressant between January 1, 2012, and September 30, 2017. All-cause health care resource utilization, total costs, and medication adherence were evaluated in two cohorts: patients with and patients without relapse. Relapse was defined as suicide attempts, psychiatric hospitalization, mental health-related emergency department (ED) visit, use of electroconvulsive therapy, or reinitiation of treatment after a gap ≥6 months.

Results: The study population included 14,186 patients (7093 baseline-matched patients per cohort). The mean follow-up period was 27.5 and 26.0 months for patients with and patients without relapse, respectively. Patients with relapse had significantly higher rates of hospitalization (16.6% vs 8.5%; p < .0001) and ED visits (54.8% vs 34.7%; p < .0001) than patients without relapse. The total costs for patients with relapse were significantly higher ($12,594 vs $10,445; p < .0001). Patients with relapse were also less adherent to antidepressants (mean proportion of days covered, 0.43 vs 0.49; p < .0001).

Conclusions: Relapse of MDD was associated with increased total costs and health care utilization and lower adherence to antidepressants. Reducing the risk of relapse may result in a reduction of the associated health care burden; however, findings may only be generalizable to patients with commercial insurance.

Keywords: Adherence; Antidepressants; Burden; Claims data; Cost; Health care utilization; Major depressive disorder; Real-world data; Relapse; Retrospective study.

The article is here.

This study, funded by Big Pharma, is mostly about antidepressant medications, but does mention ECT; and it is about relapse, a critical issue for our ECT patient population. The conclusion that relapse is associated with increased health care costs and utilization is obvious, but still necessary to study and document.

The cynical view is that this study is just an infomercial for unlimited antidepressant prescribing. But again, because relapse and its prevention are so important in our patients' lives, I think it is worth knowing about. 

Note also that it is very well written-not unexpected, given the disclosed professional writing help...

No need to read the whole paper, the abstract should suffice.