Impact of Depression on Health Care Utilization and Costs among Multimorbid Patients – Results from the MultiCare Cohort Study

Jens-Oliver Bock,Jochen Gensichen,Siegfried Weyerer,Karola Mergenthal,Birgitt Wiese,Wolfgang Maier,Melanie Luppa,Steffi Riedel-Heller,Christian Brettschneider,Hendrik Van Den Bussche,Gerhard Schön,Ingmar Schäfer,Martin Scherer,Hans-Helmut König,Angela Fuchs,Horst Bickel

doi:10.1371/journal.pone.0091973

Abstract

ObjectiveThe objective of this study was to describe and analyze the effects of depression on health care utilization and costs in a sample of multimorbid elderly patients.MethodThis cross-sectional analysis used data of a prospective cohort study, consisting of 1,050 randomly selected multimorbid primary care patients aged 65 to 85 years. Depression was defined as a score of six points or more on the Geriatric Depression Scale (GDS-15). Subjects passed a geriatric assessment, including a questionnaire for health care utilization. The impact of depression on health care costs was analyzed using multiple linear regression models. A societal perspective was adopted.ResultsPrevalence of depression was 10.7%. Mean total costs per six-month period were €8,144 (95% CI: €6,199-€10,090) in patients with depression as compared to €3,137 (95% CI: €2,735-€3,538; p<0.001) in patients without depression. The positive association between depression and total costs persisted after controlling for socio-economic variables, functional status and level of multimorbidity. In particular, multiple regression analyses showed a significant positive association between depression and pharmaceutical costs.ConclusionAmong multimorbid elderly patients, depression was associated with significantly higher health care utilization and costs. The effect of depression on costs was even greater than reported by previous studies conducted in less morbid patients.

Highlights

Depression in old age is common [1], causing substantial negative consequences for the affected individual such as decreased quality of life, functional impairment and marked disability [2]
The positive association between depression and total costs persisted after controlling for socio-economic variables, functional status and level of multimorbidity
Among multimorbid elderly patients, depression was associated with significantly higher health care utilization and costs

Summary

Introduction

Depression in old age is common [1], causing substantial negative consequences for the affected individual such as decreased quality of life, functional impairment and marked disability [2]. Several studies have shown that depression in old age is associated with higher resource utilization and costs [3]. The growing number of old people resulting from demographic aging is accompanied by an increasing number of patients living with multiple chronic conditions, referred to as multimorbidity. Multimorbidity is often defined as the co-occurrence of two or more (chronic) illnesses in one person without reference to one index disease [4] and is frequent in old age [5]. Many studies have shown that multimorbidity is associated with higher health care utilization and costs [6]. The growing number of old people with multiple chronic conditions will become more important from a health economic point of view

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Results

Discussion

Conclusion