Abstract
BackgroundThe estimated prevalence of comorbid major depressive disorder (.MDD) is 11% in patients with type 2 diabetes (T2D) and 15–20% in those with cardiovascular disease (CVD). Comorbid MDD continues to be a significant source of economic burden to the healthcare system.MethodsWe assessed the incremental healthcare burden of comorbid MDD in patients with T2D or CVD. This real-world, retrospective, administrative claims study analyzed commercially insured adults with T2D or CVD diagnosed on at least 2 separate claims within 12 months of each other (between January 1, 2011, and September 30, 2018). CVD included congestive heart failure, peripheral vascular disease, coronary heart disease, and cerebrovascular disease. The study compared patients with and without MDD with either T2D or CVD. Study assessments included all-cause healthcare resource utilization (proportion of patients with hospitalization, emergency department [ED] visits, and outpatient visits) and cost.ResultsPatients were matched by propensity score for demographics and baseline characteristics, resulting in similar baseline characteristics for the respective subcohorts. After matching, 22,892 patients with T2D (11,446 each with and without MDD) and 28,298 patients with CVD (14,149 each with and without MDD) were included.At follow-up, patients with T2D and MDD had significantly higher rates of hospitalization (26.1% vs 17.4%, P < 0.0001) and ED visits (55.3% vs 43.0%, P < 0.0001) than those observed in patients without MDD. The total cost for patients with T2D and MDD at follow-up was significantly higher than for those without MDD ($16,511 vs $11,550, P < 0.0001). Similarly, at follow-up, patients with CVD and MDD had significantly higher rates of hospitalization (45.4% vs 34.1%, P < 0.0001) and ED visits (66.5% vs 55.4%, P < 0.0001) than those observed in patients without MDD. Total cost at follow-up for patients with CVD and MDD was significantly higher than for those without MDD ($25,546 vs $18,041, P < 0.0001).ConclusionsPatients with either T2D or CVD and comorbid MDD have higher total all-cause healthcare utilization and cost than similar patients without MDD. Study findings reinforce the need for appropriate management of MDD in patients with these comorbid diseases, which in turn may result in cost reductions for payers.Trial registrationNot applicable.
Highlights
The estimated prevalence of comorbid major depressive disorder (
This study found that between 2005 and 2006, patients with type 2 diabetes (T2D) and comorbid Major depressive disorder (MDD) utilized significantly more healthcare services, such as hospitalizations, emergency department (ED) visits, and outpatient visits (P < 0.0001) than the services used by patients with T2D without comorbid MDD
Significant differences in demographic characteristics were evident between patients with and without comorbid MDD for both the T2D and cardiovascular disease (CVD) populations
Summary
The estimated prevalence of comorbid major depressive disorder MDD) is 11% in patients with type 2 diabetes (T2D) and 15–20% in those with cardiovascular disease (CVD). Major depressive disorder (MDD) is a common condition that is estimated to affect more than 17 million adults in the United States (US) [1]. Individuals with chronic medical conditions have an even higher prevalence of MDD than the average population [2]. This trend is observed in patients with cardiovascular disease (CVD) who have been shown to have an MDD prevalence of 2 to 3 times higher than that of the general population [3]. There is increasing evidence that depression and diabetes may have common pathways, such as cytokine-mediated inflammatory responses and dysregulation of the hypothalamic-pituitaryadrenal (HPA) axis [6]
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