Examining the Impact of COVID-19 on Major Depressive Disorder Diagnoses and Treatment Cost

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Major depressive disorder (MDD) is a common mental health disorder with a substantial burden. Recent data suggest that the COVID-19 pandemic increased the rate of reported depression and anxiety symptoms by three to four times. According to M. Wang and colleagues, however, few studies have characterized trends in diagnoses and economic burden of MDD during the COVID-19 pandemic. In their study, presented at AMCP 2022, they discovered that number of MDD diagnoses lowered during COVID and, in patients with MDD, health resource utilization (HRU) per-patient-per-month (PPPM) for inpatient (IP), emergency department (ED), and telehealth visits increased, whereas outpatient (OP) visits PPPM decreased.

Furthermore, the authors found that mean total all-cause ($1,264 vs. $1,121; p <0.001) and MDD-related ($354 vs. $282; p <0.001) health care costs were higher during COVID compared to pre-COVID, which the investigators concluded were both “primarily driven by higher IP costs (all-cause: $598 vs. $488; MDD-related: $178 vs. $136; both p <0.001).”

These findings were based on retrospective analyses of the IBM MarketScan Commercial claims database for the periods of May 2019–September 2019 (pre-COVID), and May 2020–September 2020 (during COVID). Patients with MDD diagnosis were identified by ≥1 IP or ED or ≥2 OP claims, and no evidence of bipolar disorder, schizophrenia, and psychosis.

Among 19,112,308 enrollees pre-COVID, 642,493 had an MDD diagnosis (3.4%), compared to 472,515 out of 18,213,478 (2.6%) enrollees during COVID. The authors reported that the demographics of patients with an MDD diagnoses in the analyzed periods were similar (mean age, 39.23 vs. 39.00 years; male, 30.2% vs. 29.5%). Additionally, the mean length of IP stays was higher during COVID compared to pre-COVID (3.78 vs. 3.38 days/stay; p <0.001)—with similar trends also being observed in MDD-related and suicide-related HRU.

The researchers concluded that “the percentage of patients with an MDD diagnosis was lower while overall HRU and costs were higher among patients with MDD” during COVID. They theorized that their findings suggested “a potential delay in seeking health care for MDD during COVID, which may, in part, explain the greater economic burden seen in this study.”