Treatment-resistant depression costs Medicare $46K per patient annually: Report

Treatment-resistant depression patients cost Medicare an average of $45,994 per year — about 21% more than comparable beneficiaries with major depressive disorder whose symptoms are controlled, according to a report from Health Management Associates. 

The research and consulting firm conducted a narrative literature review and analyzed Medicare fee-for-service and Part D claims data from 2021 to 2023 to evaluate the economic and caregiving burden of treatment-resistant depression. Researchers identified beneficiaries with major depressive disorder using qualifying inpatient and outpatient claims and classified patients as having TRD based on antidepressant treatment patterns during the 12 months after diagnosis. 

A 1:1 propensity score matching approach was used to compare 14,965 beneficiaries with TRD and 14,965 beneficiaries without TRD, controlling for demographics, psychiatric comorbidities and prior healthcare spending. Outcomes included healthcare utilization and Medicare spending across inpatient, outpatient, physician, post-acute care and prescription drug settings.

Here are seven things to know:

1. The report noted that roughly 34 million U.S. adolescents and adults experience depression, and about 1 in 3 major depressive disorder patients develop TRD.
2. The annual national burden of TRD is estimated at $29 billion to $48 billion. That represents approximately 27% to 41% of all major depressive disorder-related costs. 
3. Treatment-resistant depression patients generate significantly higher Medicare spending. Average annual spending reached $45,994 for TRD patients compared with $37,873 for matched non-TRD patients. 
4. Average inpatient spending was $13,983 for TRD patients versus $8,867 for non-TRD patients. 
5. The report cited research estimating annual major depressive disorder medication-related expenses at $92.7 billion, with $43.8 billion attributable to TRD. 
6. Incident TRD patients account for roughly $120 million in excess annual Medicare spending. Researchers noted the figure could be higher when considering prevalent TRD patients. 
7. TRD patients who received transcranial magnetic stimulation averaged about $66,769 in annual spending, while patients receiving electroconvulsive therapy generated approximately $48,000 more in annual costs than comparable non-TRD patients.

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