Burden of Treatment Failure in MDD

Major depressive disorder treatment failure can lead to subsequent costs and poor outcomes, affecting payer considerations in the treatment landscape.

H. Eric Cannon, PharmD, FAMCP: When we look at the effects of treatment failure and failure with each subsequent treatment, clearly defined medical issues go along with that. What doesn’t get factored into this a lot of times is what happens to the mental aspects of a patient who’s trying to go through that. It builds discouragement and leaves them with a feeling of failure. It’s one of those things that we’re looking for, based on this measure, if the patient has declined. Sometimes the real feelings of a patient don’t get factored into that. Somehow it needs to be taken into account that each failure is probably an exponential increase in the problem.

The issue that we’ve missed a lot of times is that we have an access issue. We don’t have enough behavioral health providers within our networks, so [it can be difficult to] find someone for a patient who can follow up with them regularly as they start this journey. There’s the prescription for the treatment, but weekly follow-up with a therapist or someone else within the behavioral health network can help a patient identify the benefits of treatment or the lack of benefit early on, which gives them some early signals to say: “Maybe we won’t wait 2 months to make a switch. Let’s make a switch here at 30 days in. We should have seen something.”

Michael Rothrock, MBA, MHA: Most PBMs [pharmacy benefit managers] and payers may not be focusing on treatment failures in this space because of the prevalence of generic options. The cost burden isn’t that significant from a pharmaceutical perspective. However, as my colleague mentioned, with each treatment failure, you’re basically resetting that patient to time 0, because now they’re starting over. See if it works. Can it be tolerated? Do they have to visit a new therapist because they aren’t getting any benefit? Is there delay in patient improvements and outcomes? Any type of downstream cost is going to be exacerbated or potentially magnified due to more cycling and treatment failure potential for patients who aren’t getting benefit.

Transcript edited for clarity.

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