Difference in Healthcare Resource Utilization and Health-Related Quality of Life between Patients with Major Depressive Disorder (MDD) and Treatment-Resistant Depression (TRD) in a Public Hospital in Malaysia – A Retrospective Case-Note Review and Cross-Sectional Survey

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Abstract

Major depressive disorder (MDD) is emerging as a common disease globally, therefore it is important to assess its economic impact on the national budget. A major contributing factor with cost implication is due to non-responsiveness towards initial treatment for MDD, resulting in progression to treatment resistant depression (TRD). Recently, National Health and Morbidity Survey 2023 had reported an increasing prevalence of depression within the Malaysian population. A cohort of 286 patients diagnosed with MDD or TRD was recruited from Psychiatry and Mental Health Clinic of Hospital Kuala Lumpur (HKL) and was retrospectively studied for 18 months. This study adopted a combined retrospective chart review and cross-sectional survey. The study was conducted from both a government and societal perspective. Results show that MDD patients were more likely to be in the lowest income range. Patients with TRD have significantly higher odds of outpatient resource utilization, including a 5-fold increase in the likelihood of having more than 10 consultation sessions (p = 0.035), and increased use of second-generation antipsychotics (p < 0.001). The average healthcare cost per patient is higher for those with TRD than for MDD (RM1,845 vs RM839 respectively, 1 Ringgit Malaysia (RM) = USD 0.22 approx.) over a period of 18 months suggesting that a 55% (or RM1,006) reduction in healthcare spending is possible if an MDD patient is prevented from progressing to TRD by proper treatment. In conclusion, appropriate care is of utmost importance to reduce the progression of MDD to TRD which would otherwise require significantly higher healthcare resource utilisation. The study highlights the need for adequate resource allocation for the early management of MDD and prevent progression to TRD.

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