The impact of treatment-resistant XXXX on health care utilization and costs.

@entity1 @entity162 @entity308 @entity148 @entity221 @entity734
BACKGROUND: Approximately 50% of @entity1 diagnosed with major @entity308 will experience a recurrent or chronic @entity221 for which long-term treatment is recommended. Moreover, at least 20% of @entity1 diagnosed with @entity308 do not respond satisfactorily to several traditional antidepressant medication treatment trials. Very little is known about the health care costs of @entity1 with treatment-resistant @entity308 . METHOD: Based on medical claims data (MarketScan Research Database, The MEDSTAT Group, Cambridge, Mass.) from January 1, 1995, to June 30, 2000, a naturalistic, retrospective analysis was conducted to study the characteristics and health care utilization of @entity1 with treatment-resistant @entity308 . All @entity1 having an International Classification of Diseases, Ninth Revision (ICD-9), diagnosis code for @entity162 with specified antidepressant dosing and treatment durations were initially selected. @entity1 were then classified as "treatment resistant" if either they switched from or augmented initial antidepressant medication with other antidepressants at least twice (outpatient treatment-resistant group) or they switched from or augmented their initial antidepressant medication and also had a claim for either a @entity308 -related hospitalization or suicide attempt (hospitalized treatment-resistant group). Those meeting the initial medication and diagnosis selection criteria but not meeting the treatment-resistance criteria constituted the comparison group. Members of the comparison group had comparatively stable antidepressant medication use patterns, consistent with an acceptable response to treatment. @entity1 were followed for a minimum of 9 months. Resource utilization was calculated from index date to last available claims data point and then annualized. RESULTS: Treatment-resistant @entity1 were more likely to be diagnosed with @entity162 or concurrent @entity734 or @entity148 than the comparison group (p <.001). Treatment-resistant @entity1 were at least twice as likely to be hospitalized (general medical and @entity308 related) and had at least 12% more outpatient visits (p <.02). Treatment resistance was also associated with use of 1.4 to 3 times more psychotropic medications (including antidepressants) (p <.001). @entity1 in the hospitalized treatment-resistant group had over 6 times the mean total medical costs of non-treatment-resistant @entity308 @entity1 ( 42,344 vs.  6512) (p <.001) and their total @entity308 -related costs were 19 times greater than those of @entity1 in the comparison group ( 28,001 vs.  1455) (p <.001). CONCLUSION: Treatment-resistant @entity308 is costly and associated with extensive use of @entity308 -related and general medical services. These findings underscore the need for early identification and effective long-term maintenance treatment for treatment-resistant @entity308 .
