Abstract
Objective <p>Increased healthcare utilization and costs have been reported in individuals with diabetes with comorbid depression. Knowledge regarding cost differences between individuals with diabetes alone and those with diabetes and diagnosed/undiagnosed depression is however scarce. We therefore compared utilization and costs for patients with diabetes and no depression and patients with diabetes and documented depression diagnosis or self-reported depression symptoms for several cost components, including mental healthcare costs.</p> <p>Research Design and Methods</p> <p>Data from a 2013 cross-sectional survey of randomly sampled members of a nationwide German statutory health insurance (SHI) provider with diabetes (n=1,634) were linked individually with SHI data covering four quarters before and after the survey. Self-reported depression symptoms were assessed using the PHQ-9, with depression diagnosis taken from SHI data. We analyzed healthcare utilization and costs, using regression analysis to calculate cost ratios adjusted for sociodemographic/socioeconomic factors and comorbidities for two groups: A) no symptoms, no diagnosis; B) symptoms or diagnosis. Our explorative sub-analysis analyzed subgroups with either symptoms or diagnosis separately.</p> <p>Results</p> <p>Annual mean total healthcare costs were higher for patients with comorbid depression (€5,629 (95% CI: €4,987-€6,407)) than without (€3,252 (95% CI: €2,976-€3,675), the cost ratio being 1.25 (1.14-1.36)). Regression analysis showed that excess costs were highly associated with comorbidities. Mental healthcare costs were very low for patients without depression (€2/€4) and still relatively low for those with depression (€111/€76). </p> <p>Conclusions</p> <p>Costs were significantly higher when comorbid depression was present, either as symptoms or diagnosed. Excess costs for mental-health services were rather low.</p>
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