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
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".