Abstract
Late-life depression has substantial impacts on individuals, families and society. Knowledge gaps remain in estimating the economic impacts associated with late-life depression by symptom severity, which has implications for resource prioritisation and research design (such as in modelling). This study examined the incremental health and social care expenditure of depressive symptoms by severity. We analysed data collected from 2707 older adults aged 60 years and over in Hong Kong. The Patient Health Questionnaire-9 (PHQ-9) and the Client Service Receipt Inventory were used, respectively, to measure depressive symptoms and service utilisation as a basis for calculating care expenditure. Two-part models were used to estimate the incremental expenditure associated with symptom severity over 1 year. The average PHQ-9 score was 6.3 (standard deviation, s.d. = 4.0). The percentages of respondents with mild, moderate and moderately severe symptoms and non-depressed were 51.8%, 13.5%, 3.7% and 31.0%, respectively. Overall, the moderately severe group generated the largest average incremental expenditure (US$5886; 95% CI 1126-10 647 or a 272% increase), followed by the mild group (US$3849; 95% CI 2520-5177 or a 176% increase) and the moderate group (US$1843; 95% CI 854-2831, or 85% increase). Non-psychiatric healthcare was the main cost component in a mild symptom group, after controlling for other chronic conditions and covariates. The average incremental association between PHQ-9 score and overall care expenditure peaked at PHQ-9 score of 4 (US$691; 95% CI 444-939), then gradually fell to negative between scores of 12 (US$ - 35; 95% CI - 530 to 460) and 19 (US$ -171; 95% CI - 417 to 76) and soared to positive and rebounded at the score of 23 (US$601; 95% CI -1652 to 2854). The association between depressive symptoms and care expenditure is stronger among older adults with mild and moderately severe symptoms. Older adults with the same symptom severity have different care utilisation and expenditure patterns. Non-psychiatric healthcare is the major cost element. These findings inform ways to optimise policy efforts to improve the financial sustainability of health and long-term care systems, including the involvement of primary care physicians and other geriatric healthcare providers in preventing and treating depression among older adults and related budgeting and accounting issues across services.
Highlights
Financing healthcare and long-term care for older persons is a major challenge for societies facing rapid population ageing (World Health Organization, 2015)
This study aims to investigate the effects of depressive symptom severity on care utilisation and expenditures across three care settings among community-dwelling older adults in Hong Kong, using two approaches to define severity: by standard cut-off points and gradual change of Patient Health Questionnaire-9 (PHQ-9) score, respectively
Depressive symptom severity and PHQ-9 scores were significantly associated with care utilisation and expenditure: compared to older adults without depressive symptoms, those with mild, moderate and moderately severe symptoms were more likely to use healthcare, rehabilitation and social care, and had higher care expenditures in healthcare settings, especially nonpsychiatric care, which were consistent with previous studies (König et al, 2019)
Summary
Financing healthcare and long-term care for older persons is a major challenge for societies facing rapid population ageing (World Health Organization, 2015). Governments should identify and manage costs falling on health and long-term care systems to ensure financial sustainability. Some costs, such as those associated with depression, are potentially avoidable (Schoevers et al, 2006). Depression is a common mental health condition among older adults (World Health Organization, 2017). It often aggravates physical health problems (Porensky et al, 2009) and increases healthcare costs (Bock et al, 2017). Economic evidence on impacts of depressive symptom severity on care utilisation and expenditure remains inconclusive because previous studies employed heterogeneous ways to categorise patients
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