Treatment-resistant depression increases health costs and resource utilization

Objective: Major Depressive Disorder (MDD) is a debilitating condition with a marked social impact. The impact of MDD and Treatment-Resistant Depression (TRD+) within the Brazilian health system is largely unknown. The goal of this study was to compare resource utilization and costs of care for treatment-resistant MDD relative to non-treatment-resistant depression (TRD-). Methods: We retrospectively analyzed the records of 212 patients who had been diagnosed with MDD according to the ICD-10 criteria. Specific criteria were used to identify patients with TRD+. Resource utilization was estimated, and the consumption of medication was annualized. We obtained information on medical visits, procedures, hospitalizations, emergency department visits and medication use related or not to MDD. Results: The sample consisted of 90 TRD+ and 122 TRD-patients. TRD+ patients used significantly more resources from the psychiatric service, but not from non-psychiatric clinics, compared to TRD-patients. Furthermore, TRD+ patients were significantly more likely to require hospitalizations. Overall, TRD+ patients imposed significantly higher (81.5%) annual costs compared to TRD-patients (R$5,520.85; US$ 3,075.34 vs. R$3,042.14; US$ 1,694.60). These findings demonstrate the burden of MDD, and especially of TRD+ patients, to the tertiary public health system. Our study should raise awareness of the impact of TRD+ and should be considered by policy makers when implementing public mental health initiatives

Resource utilization for major depressive disorder and treatment-resistant depression in a São Paulo tertiary Hospital

Objetivo: O Transtorno Depressivo Maior (TDM) é uma condição debilitante com grande impacto social. Estimativas indicam que 30% dos indivíduos com TDM são resistentes a tratamento (DRT). Os objetivos deste estudo são identificar e comparar a utilização de recursos por pacientes com DRT e com TDM não resistente no Hospital das Clínicas da FM-USP. Método: Foram analisados retrospectivamente prontuários de 212 pacientes do Instituto de Psiquiatria do hospital com diagnóstico de TDM, de acordo com os critérios da CID-10. Utilizaram-se critérios específicos para identificar os pacientes com DRT dentre aqueles diagnosticados com TDM. A utilização de recursos foi estimada contando procedimentos e insumos listados nos prontuários de 1997 a 2002. Resultados: Os pacientes com DRT utilizaram em média significantemente mais exames anualmente (11,23 vs. 8,47) e tiveram maior consumo de medicamentos e mais hospitalizações (3,53 diárias vs. 1,72). Pacientes com depressão resistente a tratamento tiveram um maior custo direto anual, R$6.171,78, do que pacientes com depressão não resistente, R$ 4.351,08 (reais de novembro de 2003). Conclusões: Pacientes com DRT utilizaram mais recursos e tiveram um custo mais elevado do que pacientes não resistentes. Este estudo é o primeiro no Brasil a avaliar o custo de tratamento da depressão e poderá ajudar a estimar o custo social da depressão.Objective: Major Depressive Disorder (MDD) is a debilitating condition with a marked social impact. Estimates indicate that 30% of individuals with MDD have treatment-resistant depression (TRD). The study objectives were to identify and compare the resource utilization by non-resistant MDD and TRD patients in a university psychiatric hospital in São Paulo- Brazil. Methods: We analyzed retrospectively 212 hospital charts of patients from the Hospital\'s Psychiatry Institute, diagnosed with MDD according to CID-10 criteria. Specific criteria were used to identify patients with TRD among those with MDD. Resource utilization was estimated by counting procedures listed on the hospital charts from 1997 to 2002. Results: Patients with TRD had on average significantly more laboratory exams yearly (11.23 vs. 8.47) than non-TRD patients, as well as more medication consumption and hospitalizations (3.53 hospital days vs.1.72). TRD patients had higher yearly treatment costs (R$6,171.78) than MDD patients (R$ 4,351.08 ) did. Conclusions: Patients with TRD used more resources and had higher direct costs than non-TRD patients. This study is the first in Brazil to evaluate depression treatment costs, and might be helpful to evaluate the economic burden of depression to society

Treatment-resistant depression increases health costs and resource utilization Depressão resistente ao tratamento aumenta os custos e utilização de recursos

OBJECTIVE: Major Depressive Disorder (MDD) is a debilitating condition with a marked social impact. The impact of MDD and Treatment-Resistant Depression (TRD+) within the Brazilian health system is largely unknown. The goal of this study was to compare resource utilization and costs of care for treatment-resistant MDD relative to non-treatment-resistant depression (TRD-). METHODS: We retrospectively analyzed the records of 212 patients who had been diagnosed with MDD according to the ICD-10 criteria. Specific criteria were used to identify patients with TRD+. Resource utilization was estimated, and the consumption of medication was annualized. We obtained information on medical visits, procedures, hospitalizations, emergency department visits and medication use related or not to MDD. RESULTS: The sample consisted of 90 TRD+ and 122 TRD- patients. TRD+ patients used significantly more resources from the psychiatric service, but not from non-psychiatric clinics, compared to TRD- patients. Furthermore, TRD+ patients were significantly more likely to require hospitalizations. Overall, TRD+ patients imposed significantly higher (81.5%) annual costs compared to TRD- patients (R$5,520.85; US$ 3,075.34 vs. R$3,042.14; US$ 1,694.60). These findings demonstrate the burden of MDD, and especially of TRD+ patients, to the tertiary public health system. Our study should raise awareness of the impact of TRD+ and should be considered by policy makers when implementing public mental health initiatives.<br>OBJETIVO: O Transtorno Depressivo Maior (TDM) é uma condição debilitante com um forte impacto social. O impacto do TDM e Depressão Resistente ao Tratamento (DRT+) no sistema de saúde brasileiro é praticamente desconhecido. Nosso objetivo é comparar a utilização de recursos e custos dos cuidados para o tratamento de DRT+ em relação ao TDM não resistente (DRT-). MÉTODOS: Foram analisados retrospectivamente os prontuários de 212 pacientes diagnosticados com TDM segundo a CID-10. Critérios específicos foram utilizados para identificar pacientes com DRT+. A utilização dos recursos foi estimada e consumo de medicamentos foram anualizados. Foram obtidas informações sobre consultas, procedimentos, internações, atendimentos no serviço de emergência e uso de medicação relacionada ou não ao TDM. RESULTADOS: A amostra foi composta de 90 pacientes DRT+ e 122 DRT-. Pacientes DRT+ utilizaram significativamente mais recursos do serviço de psiquiatria, mas não em clínicas não psiquiátricas, em relação a DRT-. Eles eram significativamente mais propensos a exigir internações. Pacientes DRT+ apresentaram um custo direto anual significativamente maior (81,5%) do que pacientes com depressão não resistente (R$5.520,85; US$ 3.075,34 contra R$3.042,14, US$ 1.694,60). Estes resultados demonstram o impacto do TDM, principalmente da DRT+ ao sistema de saúde público terciário. Nosso estudo deve aumentar a sensibilização para o impacto da DRT + e deve ser considerado pelos formuladores de políticas públicas na implementação de iniciativas de saúde mental