Economic and clinical burden of major depressive disorder with insomnia symptoms in commercially and Medicaid-insured adults in the United States: A retrospective matched cohort study

Background: Insomnia is a common symptom of major depressive disorder (MDD). Presence of insomnia symptoms in MDD (MDDIS) has been associated with worse depression severity and outcomes. This study assessed the economic and clinical burden of MDDIS in the United States.

Methods: Commercially and Medicaid-insured adults from Merative® MarketScan® Databases (01/2016-06/2021) with ≥1 MDD diagnosis (index date) were included in the MDDIS cohort if they had ≥1 insomnia diagnosis within 12 month afterwards or in the other MDD cohort if they had no insomnia diagnoses/treatments; patients without MDD diagnoses/treatments (random index date) were included in the non-MDD cohort. Cohorts were propensity score-matched. Healthcare resource utilization (HRU), costs, and treatment patterns 12 months post-index were compared between MDDIS and each control cohort using linear and Poisson regressions.

Results: In both commercially (N = 52,280; mean age: 44 years; 67 % female) and Medicaid-insured (N = 15,653; mean age: 41 years; 73 % female) populations, the MDDIS cohort had significantly higher HRU and cost than the other MDD and non-MDD cohorts. Mean total all-cause healthcare cost difference between the MDDIS and other MDD cohort was $5842 (commercial) and $5152 (Medicaid); between the MDDIS and non-MDD cohort, it was $14,266 (commercial) and $11,314 (Medicaid). MDDIS compared to other MDD was associated with higher use of antidepressants, particularly agents with sedative effect.

Limitations: Data were subject to incompleteness that might lead to measurement biases.

Conclusions: MDDIS compared to other MDD and non-MDD was associated with significantly higher economic and clinical burden, highlighting the need for effective treatments for this population.