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To gain a better understanding of the characteristics of patients with a hospital encounter for major depressive disorder (MDD) and evaluate associated hospital resource utilization, hospital charges and costs, and hospital re-encounters.Adult patients with a hospital encounter (i.e. emergency department [ED] visit only or inpatient admission) with MDD as the primary discharge diagnosis (index event) during July 2018‒March 2019 were selected from the Premier Healthcare Database. Patient characteristics, hospital resource utilization, and hospital charges and costs were evaluated during index events. During a 12-month follow-up, hospital re-encounters (MDD-related and all-cause ED visit only or inpatient readmissions) were examined.The study population included 77,178 patients with an index hospital encounter (ED visit only: 49.9%; inpatient admission: 50.1%) for MDD. The most common secondary mental health-related diagnosis was suicidal ideation/behavior, which was recorded in 51.8% of patients. The mean age was 38.2 years, 53.0% were female, and 72.1% were Caucasian. Among patients with an ED visit only, the mean index hospital charges and costs were $3,608 and $639, respectively. Among those with inpatient admissions, the mean length of stay was 4.9 days, and the mean index hospital charges and costs were $17,107 and $6,095, respectively. During the 12-month follow-up, 13.3% of patients in the overall study population had an MDD-related hospital re-encounter (primary or secondary discharge diagnosis code indicating MDD); nearly one-third (31.3%) occurred within 30 days post-discharge. During the follow-up, 28.1% had an all-cause hospital re-encounter with 29.7% having occurred within 30 days post-discharge.Due to constraints of the Premier Healthcare Database, healthcare resource utilization and costs outside of the hospital could not be evaluated.Patients with a hospital encounter for MDD are relatively young, commonly have suicidal ideation/behavior, utilize substantial hospital resources, and have a high risk for a hospital re-encounter in the 30 days post-discharge.

Background: Though oral antidepressants can be effective at reducing depressive symptoms, they can take 4–6 weeks to reach full effect. Limitations relating to slow onset of action and resistance to current treatments for patients with major depressive disorder (MDD), particularly for MDD in a psychiatric emergency such as major depressive disorder with acute suicidal ideation or behavior (MDSI), is an issue across all countries and healthcare settings. Due to the current unmet needs and slow onset of action from oral antidepressants, patients with MDSI need interventions that provide a rapid relief of depressive symptoms. This study aimed to identify unmet needs in the treatment for MDSI, specifically exploring the potential clinical benefits of a rapid reduction of depressive symptoms, associated with treatment with rapid acting antidepressant such as esketamine nasal spray. Methods: A Delphi panel consisting of independent psychiatrists experienced in treating patients with MDSI (n=12) from the United States, Canada, United Kingdom, and European Union, was conducted between December 2020–June 2021. Psychiatrists were recruited and screened by an independent party to ensure that they had the required experience. Psychiatrists completed two rounds of anonymized questionnaires, and a virtual consensus meeting to collect their perceptive on current treatments for MDSI. Results: This research confirmed current unmet needs in the treatment of patients with MDSI. Hopelessness, functional impairment, worsening of symptoms, recurrent hospitalization and higher risk of suicide attempt were considered key consequences of the slow onset of action of oral antidepressants. Psychiatrists anticipated that treatment with rapid-acting antidepressants would provide benefits such as shorter hospital stays, improved patient engagement/compliance, and improved patient outcomes. For long-term benefits, psychiatrists agreed that improved daily functioning and increased trust/confidence in treatment options were key benefits of rapid-acting antidepressants. Conclusions: These findings suggest that the use of rapid-acting antidepressants such as esketamine nasal spray, in a psychiatric emergency, may help alleviate some of the current unmet needs experienced by patients with MDSI. This Delphi panel of psychiatrists highlighted that treatment with rapid-acting antidepressants can provide clinically meaningful benefits in the and long-term, as well as the immediate- and short-term, for patients with MDSI.

There is limited published information about the management of patients with major depressive disorder (MDD) hospitalised for acute suicidal ideation (SI). This study aimed to identify treatment patterns and unmet needs in the management of these patients and the decision drivers for hospital discharge.Cross-sectional survey-based study enrolling hospital-based European psychiatrists. The study had a qualitative and a quantitative stage, including a conjoint exercise.Each respondent (N = 413) managed, on average, 62 MDD patients with acute SI per typical three-month period; 76% of these patients required hospitalisation. Severity of SI and severity of MDD were considered the most important factors for hospital admission and discharge. In the conjoint analysis, these attributes accounted for 54% of the discharge decision. Key treatment goals included improving depressive symptoms and achieving MDD remission. Antidepressants were a standard treatment for 98% of respondents but 63% defined rapid onset of action as a critical unmet need, followed by a good tolerability profile (34%).The study has a cross-sectional design representing respondents' behaviour and attitudes at a particular point in time. In the conjoint analysis, the results represent stated behaviour and not observed clinical behaviour.Physicians' decisions to admit and discharge patients with MDD hospitalised for acute SI are mostly driven by the severity of SI and depression. Antidepressants with rapid onset of action, which can quickly improve depressive symptoms, represent a key unmet need for these patients and may contribute to a higher likelihood of early discharge.

Objective This analysis was conducted to understand the clinical practice on FL treatment in patients with MM across EU5 countries. Methods Real world data were collected through Adelphi's Disease-Specific ProgrammeTM - a point in time survey administered to physicians (n=241) in EU5 countries between Nov 2017 - Feb 2018. Stem Cell Transplant eligibility and treatments, including number of cycles and dosage, were collected from patient record forms (n=1952). Summary statistics were reported and analysed descriptively. Results Data on FL treatment was collected for 1952 patients; 988 (51%) were still on FL treatment at the time of data collection. Bortezomib-based regimens were used in more than 70% of patients - in both transplanted/transplant eligible (TE, n=572) and non-transplanted/transplant ineligible patients (TIE, n= 1380). In TIE patients, bortezomib, melphalan and dexamethasone (VMP) was the most commonly used regimen, covering almost one third of the patients (31%), followed by bortezomib, either in combination with cyclophosphamide and dexamethasone (VCD, 10%) or thalidomide and dexamethasone (VTD, 10%). The other two FL regimens currently approved in Europe - thalidomide, melphalan and dexamethasone (MPT) and lenalidomide and dexamethasone (Rd) have patient shares of 9% each. When analyzing the TIE patients undergoing FL treatment at time of data collection (n=606), VMP remained the most used regimen (29%) and Rd the second (15%), with VTD and MPT being used in 8% of patients. In TE patients, VTD was the most commonly used induction regimen, being used in 50% of patients, followed by VCD (21%). The numbers remained the same when analyzing the TE patients in FL treatment at time of data collection (n=382), with 54% and 22% using VTD and VCD, respectively. Conclusions Collectively these results indicate that bortezomib-based regimens remain the standard of care in FL treatment of MM in EU5, in both transplant and non-transplant settings. Disclosures Anjo: Janssen: Employment. Rider:Adelphi Real World: Employment. Bailey:Adelphi Real World: Employment. Gaudig:Janssen: Employment.