Depression Health Care Costs Research Articles

Caring for People With Depression: Costs Among 43 Million Commercially Insured Patients With or Without Comorbid Illnesses.

Depression is a common comorbidity for patients with chronic medical conditions. Although the costs of treating chronic medical illness in combination with depression are believed to be significantly higher than the costs of treating each condition independently, few studies have formally modeled the cost consequences of mental health comorbidity. To estimate the relative magnitude of the independent and synergistic contributions to health care costs from depression diagnosis and other chronic physical health conditions. Cross-sectional, observational study using all individuals >18 years of age in the national Blue Cross Blue Shield (BCBS) Axis claims database (N = 43,872,144) from calendar year 2018. General linear models with and without interaction terms were used to assess the relative magnitude of independent and synergistic contributions to total annual health care costs of depression alone and in combination with coronary heart disease, chronic kidney disease, chronic obstructive pulmonary disease, diabetes (both types 1 and 2), hypertension, and arthritis. The incremental annual cost associated with having a diagnosis of depression was $2,951 compared to $1,986-$6,251 for the other chronic physical conditions. The interaction between depression and chronic conditions accounted for less than one-hundredth of the amount of variation in costs explained by the main effects of depression and each chronic physical condition. The independent increase in total annual health care costs associated with a depression diagnosis was comparable to that of many common physical chronic conditions. This finding underscores the importance of health care service and payment models that acknowledge depression as an equal contributor to overall health care costs. The combination of depression and another chronic condition did not synergistically increase total annual health care costs beyond the increases in costs associated with each condition independently. This finding has implications for simplifying risk adjustment models.

Quantifying the Economic Impact of Depression for Spine Patients in the United States.

This was a retrospective cross-sectional analysis. The objective of this study was to estimate the incremental health care costs of depression in patients with spine pathology and offer insight into the drivers behind the increased cost burden. Low back pain is estimated to cost over $100 billion per year in the United States. Depression has been shown to negatively impact clinical outcomes in patients with low back pain and those undergoing spine surgery. Data was collected from the Medical Expenditure Panel Survey from 2007 to 2015. Spine patients were identified and stratified based on concurrent depression International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Health care utilization and expenditures were analyzed between patients with and without depression using a multivariate 2-part logistic regression with adjustments for sociodemographic characteristics and Charlson Comorbidity Index. A total of 37,094 patients over 18 years old with a spine condition were included (mean expenditure: $7829±241.67). Of these patients, 7986 had depression (mean expenditure: $11,455.41±651.25) and 29,108 did not have depression (mean expenditure: $6837.89±244.51). The cost of care for spine patients with depression was 1.42 times higher (95% confidence interval, 1.34-1.52; P<0.001) than patients without depression. The incremental expenditure of spine patients with depression was $3388.22 (95% confidence interval, 2906.60-3918.96; P<0.001). Comorbid depression was associated with greater inpatient, outpatient, emergency room, home health, and prescription medication utilization and expenditures compared with the nondepressed cohort. Spine patients with depression had significantly increased incremental economic cost of nearly $3500 more annually than those without depression. When extrapolated nationally, this translates to an additional $27.5 billion annually in incremental expenditures that can be attributed directly to depression among spine patients, which equates to roughly 10% of the total estimated spending on depression nationally. Strategies focused on optimizing the treatment of depression have the potential for dramatically reducing health care costs in spine surgery patients.

Health care costs of depression in patients diagnosed with cancer.

Depression is common among patients diagnosed with cancer. Patients with cancer and depression use more health care services compared with nondepressed cancer patients. The current study seeks to estimate the added cost of depression in cancer patients in the first year after cancer diagnosis. Health care charges were obtained for 2051 depressed and 11182 nondepressed patients with an International Classification of Diseases, Ninth Revision, diagnosis of cancer in the 2014 calendar year from the University of California San Diego Healthcare System. The annual health care charges for cancer patients with and without depression were analyzed using generalized linear models with a log-link function and gamma distribution, covarying for age, sex, race/ethnicity, comorbid diseases, and presence of metastatic disease. Total cost data were broken down into several categories including ambulatory care, emergency department visits, and hospital visits. Depressed cancer patients had total annual health care charges that were 113% higher than nondepressed cancer patients (B=0.76; P<.001). The estimated mean charges for depressed patients were $235337 compared with $110650 for nondepressed patients. Depressed cancer patients incurred greater charges than nondepressed patients in ambulatory care (B=0.70; P<.001), emergency department charges (B=0.31; P<.001), and hospital charges (B=0.39; P<.001). Depressed cancer patients incur significantly higher health care charges across multiple cost categories including ambulatory care, emergency department visits, and hospital visits. Future research should investigate if interventions for detecting and treating depression are effective for reducing health care use and costs in cancer patients.

Health care costs of depression in primary care patients in The Netherlands

Depression is highly prevalent in Western countries and is associated with increased health care costs. Most depressed patients are treated in primary care. To estimate the resource use and costs of depressed patients treated in primary care in comparison with matched controls. Data from an electronic medical record system of 20 general practices in The Netherlands for the years 2002-04 were used. A patient was considered depressed when having a diagnosis of depression and either a prescription for antidepressants or a referral to mental health care. Matching was based on age, sex and GP. Multilevel analyses combined with bootstrapping were performed to compare costs between depressed and matched control patients while correcting for clustering at the level of the GP and adjusting for confounding by age, sex and co-morbidity. The prevalence of recognized and subsequently treated depression was 3.1% [95% confidence interval (CI) 3.0 to 3.2]. Total health care costs per patient in 2002-04 were on average €2859 (SD 2297) in depressed patients and €658 (SD 1070) in control patients (mean difference €2202, 95% CI 2146 to 2257). After adjustment for co-morbidity, depressed patients had excess costs of €1403 (95% CI 1350 to 1456). Our results show that health care costs of depressed patients are much higher compared with matched controls even after adjusting for co-morbidity. This was not only true for mental but also for general medical care utilization. These results emphasize the need to develop cost-effective interventions to treat depression in primary care.

Healthcare costs associated with recognized and unrecognized depression in old age

Inadequate recognition of depression in old age in primary care and the consequences for individuals are now well reported, but little research has been undertaken on its impact on healthcare costs. It is not known whether these costs (i) differ between GP-recognized and -unrecognized depressed individuals, and (ii) differ between these groups and non-depressed individuals. 451 primary care patients aged 75+ were interviewed face-to-face regarding depressive symptoms (Geriatric Depression Scale), chronic medical illness (Chronic Disease Score), resource utilization and healthcare costs (questionnaire of service utilization and costs). A general practitioner (GP) questionnaire was used to measure GPs' recognition of depression. Resource utilization was valued in monetary terms using 2004/2005 prices. Thirty-eight (60%) of the 63 depressed patients were not identified by the GPs. From a societal perspective, mean annual healthcare costs were euro 5,582 for unrecognized depressed and euro 4,722 for recognized depressed patients with no significant difference. Healthcare costs of recognized and unrecognized depressed exceeded the healthcare costs of non-depressed patients (euro 3,648) by 23% and 35% respectively (p < 0.05). Although mean annual healthcare costs for GP-unrecognized depressed patients exceed the costs of GP-recognized depressed patients in absolute numbers, differences were not found to be statistically significant. Both groups differ from non-depressed individuals regarding their healthcare costs. Results encourage further research into the effect of recognition on healthcare costs of depression in large-scale studies.