The economic cost of treatment-resistant depression in patients referred to a specialist service

McCrone, Paul; Rost, Felicitas; Koeser, Leonardo; Koutoufa, Iakovina; Stephanou, Stephanie; Knapp, Martin; Goldberg, David; Taylor, David and Fonagy, Peter (2018). The economic cost of treatment-resistant depression in patients referred to a specialist service. Journal of Mental Health, 27(6) pp. 567–573.

DOI: https://doi.org/10.1080/09638237.2017.1417562

Abstract

Background: Patients with treatment-resistant depression (TRD) suffer very significant morbidity and are at a disadvantage concerning optimal clinical management. There are high associated societal costs.

Aims: A detailed analysis of health economic costs in the United Kingdom in a group manifesting a severe form of TRD in the 12 months before their participation in a major randomized controlled treatment trial.

Methods: The sample consisted of 118 participants from the Tavistock Adult Depression Study. Recruitment was from primary care on the basis of current major depression disorder of at least 2 years’ duration and two failed treatment attempts. Service utilization was assessed based on self-report and general practitioner (GP) medical records. Generalized linear models were used to identify predictors of cost. Results: All participants used GP services. Use of other doctors and practice nurses was also high. The mean total societal cost was £22 124, 80% of which was due to lost work and care required of families. Level of general functioning was found to be the most consistent predictor of costs. Conclusions: Severe forms of TRD are associated with high costs in which unpaid care and lost work predominate. Treatments that improve functioning may reduce the large degree of burden.

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