title: Treatment-resistant depression increases health costs and resource utilization.
abstract: 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.
authors: Faculdade de Saúde Pública, Universidade de São Paulo, Brazil.
authors: Beatrice Alinka
authors: BA
authors: Lepine
authors: Ricardo Alberto
authors: RA
authors: Moreno
authors: Rodolfo Nunes
authors: RN
authors: Campos
authors: Bernard François
authors: BF
authors: Couttolenc
mesh_terms: D001938:Brazil; D003365:Costs and Cost Analysis; D003865:Major Depressive Disorder / Q000191:economics* / Q000628:therapy*; D061218:Depressive Disorder, Treatment-Resistant / Q000191:economics*; D005260:Female; D017048:Health Care Costs; D006295:Health Resources / Q000191:economics* / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies