Abstract
BackgroundThere are many studies in the literature on the association between depression treatment and health expenditures. However, there is a knowledge gap in examining this relationship taking into account coexisting chronic conditions among patients with diabetes. We aim to analyze the association between depression treatment and healthcare expenditures among adults with Type 2 Diabetes Mellitus (T2DM) and newly-diagnosed depression, with consideration of coexisting chronic physical conditions.MethodsWe used multi-state Medicaid data (2000–2008) and adopted a retrospective longitudinal cohort design. Medical conditions were identified using diagnosis codes (ICD-9-CM and CPT systems). Healthcare expenditures were aggregated for each month for 12 months. Types of coexisting chronic physical conditions were hierarchically grouped into: dominant, concordant, discordant, and both concordant and discordant. Depression treatment categories were as follows: antidepressants or psychotherapy, both antidepressants and psychotherapy, and no treatment. We used linear mixed-effects models on log-transformed expenditures (total and T2DM-related) to examine the relationship between depression treatment and health expenditures. The analyses were conducted on the overall study population and also on subgroups that had coexisting chronic physical conditions.ResultsTotal healthcare expenditures were reduced by treatment with antidepressants (16 % reduction), psychotherapy (22 %), and both therapy types in combination (28 %) compared to no depression treatment. Treatment with both antidepressants and psychotherapy was associated with reductions in total healthcare expenditures among all groups that had a coexisting chronic physical condition.ConclusionsAmong adults with T2DM and chronic conditions, treatment with both antidepressants and psychotherapy may result in economic benefits.
Highlights
There are many studies in the literature on the association between depression treatment and health expenditures
Randomized clinical trials have studied whether depression treatment delivered in primary care-based collaborative care settings among individuals with both depression and Type 2 Diabetes Mellitus (T2DM) reduces healthcare expenditures when compared to usual care, in which referrals to outside mental healthcare professionals are given [19, 22, 39]
In the study population (N = 5295), 36.3 % were aged 45–54 years, 38.5 % were between 55–64 years of age, and 25.2 % were aged 18–44 years; 67.3 % were female and 32.7 % were male; 26.8 % were white, 30.1 % were African American, and 43 % belonged to another race; the majority (89.1 %) lived in metro areas. 16.8 % lived in counties that were designated as shortage areas for mental health professionals and 51.1 % lived in counties without a community mental health clinic
Summary
There are many studies in the literature on the association between depression treatment and health expenditures. Individuals with coexisting type 2 diabetes mellitus (T2DM) and depression use more healthcare services including inpatient care [12], outpatient care [11, 30], and prescription drug use [11, 30]. These patients’ records show higher total medical expenses [6, 11, 12], as well as T2DM-related medical care expenditures, when compared to individuals with T2DM and no depression [23]. A study using elderly Medicare patient data found that beneficiaries with coexisting depression and chronic disease who received depression treatment had higher expenditures compared to patients not receiving depression treatment [5]
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