Depression-related costs in heart failure care.
BACKGROUND
Behavioral factors may play a role in heart failure (HF) care costs by increasing hospital readmission rates. This study sought to estimate the effect of depression on health care costs for patients hospitalized for HF.


METHODS
A 3-year retrospective cohort study of a staff-model health maintenance organization. Following a first hospitalization with a primary diagnosis of HF, 1098 health maintenance organization patients were evaluated. Median annualized health care costs for 3 depression groups were identified: (1) no depression (n = 672; cost, $7474), (2) antidepressant prescription only (n = 312; cost, $11 012), and (3) antidepressant prescription and depression diagnosis recorded (n = 114; cost, $9550). Depression and HF status were determined through diagnostic, laboratory, and pharmacy records. Actual utilization and cost values were derived from administrative data.


RESULTS
After adjusting for age, sex, medical comorbidity, and length of stay at index hospitalization (as proxy for HF severity), costs were 26% higher in the antidepressant prescription only group and 29% higher in the antidepressant prescription and depression diagnosis recorded group when compared with the no depression group (both P<.001). Increased inpatient and outpatient utilization contributed to the increased costs.


CONCLUSIONS
Costs of care for patients hospitalized for HF are significantly higher for patients with evidence of depression.
Department of Psychiatry and Behavioral Sciences, University of Washington, Box 356560, Seattle, WA 98195, USA. sullimar@u.washington.edu
Mark
M
Sullivan
Greg
G
Simon
John
J
Spertus
Joan
J
Russo
D000368:Aged; D000928:Antidepressive Agents / Q000191:economics / Q000627:therapeutic use; D015331:Cohort Studies; D003863:Depression / Q000191:economics* / Q000209:etiology* / Q000628:therapy; D005260:Female; D017048:Health Care Costs; D006279:Health Maintenance Organizations / Q000191:economics; D006296:Health Services / Q000706:statistics & numerical data; D006333:Heart Failure / Q000191:economics* / Q000523:psychology*; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
D000928:Antidepressive Agents