Private-payer Costs for Employees with Treatment-resistant Depression

Objective: Individuals with treatment-resistant depression (TRD) do not achieve and sustain remission after multiple pharmacotherapies. The impact on employment is unknown. Our objective was to investigate the expenditures of TRD from a private-payer perspective in Canada. Methods: An employer-sponsored benefits plan database (20112012) was used to define a cohort of non-TRD and TRD employee claimants. The employees' covered family members were not included. TRD employee claimants were defined as those employees with previous experience with a number of antidepressants. The costs of prescription medication utilization, short-term disability (STD), and long-term disability (LTD) benefits were calculated (2011 and 2012 $ CAN) for both non-TRD and TRD groups. Descriptive statistics were used to characterize the cohort of employee claimants and the resources and costs for employee claims. Results: There were 55,324 and 61,028 employee claimants in 2011 and 2012, respectively. Approximately 10% of employee claimants (9.9% in 2011, 9.7% in 2012) were treated for depression, and 1.3% of employee claimants were classified as TRD employee claimants. The medication costs for treating depression were approximately $ 780 per TRD employee claimant compared with similar to$ 300 per non-TRD employee claimant. Weighted average STD costs per employee disability claimant were approximately $ 7300 for TRD and $ 5000 for non-TRD. Weighted average LTD costs per employee disability claimant were approximately $ 13,800 for TRD and $ 12,600 for non-TRD. Conclusions: Employee claimants identified with TRD had higher medication, STD, and LTD costs than those with non-TRD. Limitations include lack of diagnostic information for employee claimants and small sample sizes for STD and LTD subgroups.