All-Cause Healthcare Payments Substantial for Younger Adults With Depression, and Other Poster Findings at ISPOR

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Posters presented at the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) 23rd Annual International Meeting in Baltimore, Maryland, highlighted healthcare costs for patients with treatment-resistant depression, off-label drug use in children with depressive disorder, and incidence of depression in patients diagnosed with late-stage cancer.

Patients experiencing episodes of major depressive disorder (MDD) that have not responded to at least 2 adequate lines of depression therapy are defined as having treatment-resistant depression (TRD). A study presented at the ISPOR meeting¹ used data from Truven Health MarketScan Commercial and Medicare Supplemental Databases between October 1, 2008, and September 30, 2016, on patients with TRD who were 18 years or older, newly diagnosed with MDD, and newly treated with 3 or more courses of depression therapy. The third course of therapy served as the TRD index date.

In total, there were 1112 patients with TRD analyzed in the study. They were continuously enrolled for 12 months from baseline before the first course of therapy and followed for 12 months after their TRD index date (the time of the third course of therapy).

The researchers found that the mean total annual all-cause healthcare payments were $10,161 per patient in the follow-up period. More than one-third ($3423) were outpatient payments. They also found that being younger than age 65, being obese and having pain at baseline, having a higher Charlson comorbidity score (2 or higher), and having baseline resource use (emergency department visit, outpatient visit, or other visit) were associated with higher all-cause healthcare payments during the follow-up period.

The authors concluded that the annual all-cause healthcare payments in the 12 months after being defined as having TRD can be substantial for younger adults with obesity or pain. “Efforts to reduce this economic burden are warranted,” the authors concluded.

A second poster² at ISPOR analyzed off-label drug use in children and adolescents with major depression. Currently, there are limited FDA-approved medications to treat depression in the pediatric population. As a result, off-label drug use is common, but “healthcare providers should be aware that its safety and efficacy in pediatric patients have not been fully established,” the authors noted.

The population-based study used data from 2010 to 2014 from the National Ambulatory Medical Care Survey. Among the 23.3 million outpatient visits with depression, 5.5% were children. Of those visits, 82.4% received at least 1 off-label medication with selective serotonin reuptake inhibitors being the most frequently used off label, followed by phenylpiperazine and atypical antipsychotics.

“It is important for FDA and researchers to remain committed to keeping pediatric drug development a high priority and to ensuring those drugs are appropriately labeled for children,” the authors concluded.

Finally, a third study³ looked at trends of depression among patients with late-stage cancer. Depression is one of the most common illnesses among patients with cancer, and this poster sought to understand the demographic profile on the incidence of depression after the diagnosis of late-stage cancer.

More than 123,000 patients diagnosed with late-stage breast, prostate, lung, or colorectal cancer between 2001 to 2013 in the Surveillance, Epidemiology, and End Results Medicare-linked database. The researchers found the incidence of depression after a late-stage cancer diagnosis increased from 13.2% in 2001 to 21.4% in 2013. Furthermore, the data showed that non-Hispanic whites and women were most likely to be diagnosed with depression during the mean follow-up of 6.6 months after diagnosis.

The analysis of racial/ethnic groups found 17.1% of non-Hispanic whites, 13.3% of non-Hispanic blacks, and 10.7% of Hispanics were diagnosed with depression. Nearly one-fifth (19.3%) of women were diagnosed with depression compared with 13.9% of men.

“The consideration of racial/ethnic and gender status in depression prevention and diagnosis among cancer patients should be discussed as a matter of importance to ensure that there is no diagnosis bias among men, non-Hispanic blacks, and Hispanics,” the authors concluded.

References

1. Sussman M, O’Sullivan A, Shah A, Menzin J, Olfson M. Predictors of all-cause healthcare payments among patients with treatment-resistant major depressive disorder. Presented at the International Society for Pharmacoeconomics and Outcomes Research 23rd Annual International Meeting. May 22, 2018; Baltimore, Maryland. Abstract PMH23.

2. Lai L, Vuong D, Ting A, et al. Off-label drug use in children and adolescents with depressive disorder. Presented at the International Society for Pharmacoeconomics and Outcomes Research 23rd Annual International Meeting. May 22, 2018; Baltimore, Maryland. Abstract PIH41.

3. Huo J, Hong Y, Xiao H, Wilkie DJ. Patterns of post-diagnosis depression among late-stage cancer patients: do racial/ethnic and gender disparities exist? Presented at the International Society for Pharmacoeconomics and Outcomes Research 23rd Annual International Meeting. May 22, 2018; Baltimore, Maryland. Abstract PCN39.