Clinical Summary
Clinical Summary: The Economic Burden of Adults With Major Depressive Disorder in the United States (2005 and 2010)
Major depressive disorder imposes costs far beyond the psychiatric visit, with much of the burden arising from comorbid conditions and lost work rather than depression treatment itself. For clinicians, this reframes major depressive disorder as a disorder with substantial medical and occupational consequences that extend well beyond symptom management.
Design
Using national survey (DSM-IV criteria) and administrative claims data (ICD-9 codes), we estimate the incremental economic burden of individuals with MDD as well as the share of these costs attributable to MDD, with attention to any changes that occurred between 2005 and 2010.
N
over 16 million beneficiaries (ie, employees, spouses, and dependents) from 69 large, self-insured US companies
Population
Individuals aged 18-64 years with diagnosed MDD in 2005 or 2010 (study years)
Duration
between 2005 and 2010
Key Findings
- The incremental economic burden of individuals with MDD increased by 21.5%, from $173.2 billion in 2005 to $210.5 billion in 2010.
- Only 38% of the total incremental costs were attributable to MDD itself as opposed to comorbid conditions.
- Direct costs incurred by individuals with MDD totaled $77.5 billion in 2005 and rose 27.5% to $98.9 billion in 2010, while the composition of total incremental costs remained stable with 45%-47% attributable to direct costs, 48%-50% to workplace costs, and 5% to suicide-related costs.
- Among employed and treated patients, incremental direct costs of health care services were $5,707 per MDD patient in 2005 and increased by 5% to $5,988 in 2010; in both study years, only 40% of these incremental direct costs were directly attributable to MDD, 10%-11% to depression other than MDD, and 48%-51% to other conditions.
- Presenteeism accounted for approximately 3 quarters of workplace costs and represented 37% of the overall economic burden; total presenteeism costs were $64.7 billion in 2005 and rose 21.5% to $78.7 billion in 2010, while absenteeism costs increased 8.4% from $21.5 billion to $23.3 billion.
Clinical Bottom Line
The economic burden of major depressive disorder is large, growing, and driven more by comorbid conditions and workplace impairment than by direct depression treatment costs alone. Major depressive disorder care should be approached with attention to functional recovery and comorbid medical and psychiatric burden, not just depressive symptoms.
Practice Implications
- When treating major depressive disorder, assess and manage comorbid psychiatric and physical conditions because only 38% of total incremental costs were attributable to MDD itself.
- Monitor work functioning directly, not just absenteeism, because presenteeism accounted for approximately 3 quarters of workplace costs and represented 37% of the overall economic burden.
- Do not equate rising treatment rates with adequate population management: the treatment rate increased from 52.2% to 56.2%, yet the overall burden still rose from $173.2 billion to $210.5 billion.
- Consider collaborative care and broader medical coordination in adults with major depressive disorder, especially when pain syndromes, sleep disorders, migraines, anxiety, adjustment disorder, or posttraumatic stress disorder are present, because 48%-51% of incremental direct costs in employed and treated patients stemmed from other conditions.
