Introduction to the Special Issue of PharmacoEconomics on Major Depressive Disorders

We started talking with Chris Carswell about a special themed issue of PharmacoEconomics on major depressive disorders (MDDs) in December 2019, and the call for papers was issued shortly thereafter in January 2020. The topics we set out to cover from the perspectives of multiple geographic jurisdictions included epidemiologic estimates of MDD and its treatment, economic burden, cost effectiveness of treatment, and methodological challenges (e.g., associated with special patient populations and database analyses). We suggested this overarching topic for a special themed issue because we sensed that the international pharmacoeconomic research community would have much to say about this widespread, debilitating, and economically burdensome mental illness. On that, we were exactly right, as evidenced by the wonderful collection of important papers that make up this special issue.

We could not have known in late 2019 or early 2020 the level of devastation about to be caused by the once-in-a-century pandemic and resulting economic shutdown. The effects of the combination of coronavirus disease 2019 (COVID-19) and the policy measures designed to limit both its spread and the severity of its adverse medical consequences has been staggering. One particularly striking change relative to the pre-pandemic period summarizes the enormity of the problem in this new era. In 2019, the US Centers for Disease Control estimated that the US prevalence of MDD was approximately 7%, and this skyrocketed to 27% during the pandemic. This stunning new reality has no obvious precedent in terms of the sudden spike in magnitude that will also endure for quite a while.

It is not clear how these fundamental changes in the prevalence landscape will affect the economic consequences of MDD. Will there be an accompanying tripling or quadrupling of the economic burden? How will treatment rates adjust, and what will be the role of new treatment approaches (e.g., telemedicine, smart phone apps). For people who have been able to work from home during the pandemic, is the longstanding distinction between absenteeism and presenteeism still meaningful, and, if not, how should we think about indirect costs in the workplace when many people with MDD now work from home? For people whose first episode of MDD occurred during the pandemic, how enduring will their economic burden be once the pandemic retreats as a cataclysmic public health concern? These topics are so new that it will take several years to amass relevant data that can shine a bright light on their complicated dynamics.

We began studying the economic burden of MDD 30 years ago. With each research milestone along the way, we have always been impressed by a combination of how much we learn about this topic and how much more research is needed to better understand all the complexities associated with the burden of MDD and its treatment. The compilation contained in this special issue furthers that advance while also pointing to new research directions for future initiatives in this context.

Guest editors

Paul E. Greenberg

Managing Principal and Director, Health Care Practice

Tammy Sisitsky

Senior Advisor

Declarations

Conflict of interest

Paul E. Greenberg and Tammy Sisitsky have no conflicts of interest that are directly relevant to the content of this article.