Economic Burden of Treatment-Resistant Depression

Background: Treatment-resistant depression (TRD) is a highly prevalent condition and is generally referred to as the failure of at least two or more prior treatments with antidepressants or augmentation therapy with adequate dose and duration. TRD affects the overall health and social life of the individual, in addition to the economic impact associated with the illness. Therefore, this review is focused to examine the financial burden of illness among patients with TRD across different countries and to identify the key drivers for the incremental costs and healthcare resource utilization (HRU). Methods: Literature search was carried out in the PubMed database using relevant MeSH terms. Relevant studies published between 2019 and 2024 were included in this review. Results and Discussion: Overall 22 studies were included in this review, with majority based of the United States (n=15). The majority of the patients were females, ranging from 53.1% to 77% and the mean age of patients with TRD ranged from 37.7±14.4 to 73.1±6.5 years. The mean annual all-cause healthcare cost per patient ranged from $3,190 to $40,040. The mean annual all-cause indirect costs per patient ranged from $4,199 to $6,342. Outpatient visits were the frequently utilized healthcare services, especially psychiatric visits and visits to the general practitioners or family physician. The incremental costs were primarily driven by worsening symptom severity, presence of comorbidities, advancing age, and frequent visits to specialists. Conclusion: Regardless of the factors influencing cost burden, TRD generally accounts for higher healthcare use and costs, compared to individuals with major depressive disorder or without any mental illness. This underscores the need for fostering newer interventions and implementation of multidisciplinary approaches to lessen the cost burden of this condition, in addition to managing it effectively.