Healthcare costs associated with depression in medically Ill fee-for-service medicare participants.
OBJECTIVE
To examine the association between depression and healthcare costs in medically ill fee-for-service (FFS) Medicare recipients.


METHODS
Observational analysis of Medicare claims data.


METHODS
Medicare Health Support (MHS) program at Green Ribbon Health.


METHODS
Fourteen thousand nine hundred two participants with diabetes mellitus, congestive heart failure (CHF), or both.


METHODS
This study examined participant data for a 12-month period before MHS enrollment (collected between November 2004 and August 2006). Twelve-month healthcare costs (based on Medicare claims) in 2,108 participants with International Classification of Diseases, Ninth Revision, claims diagnoses of depression, 1,081 participants with possible depression (positive depression screen on the two-item Patient Health Questionnaire or self reported antidepressant use), and 11,713 participants without depression were compared. Gamma regression models were used to adjust for demographic and clinical differences and nonnormal distribution of cost data.


RESULTS
Participants with depression had significantly higher total healthcare costs than those without ($20,046 vs $11,956; P<.01). Higher costs were observed in participants with depression in every cost category except specialty mental health care, which accounted for less than 1% of total healthcare costs. Participants with depression had higher costs in each quartile of increasing medical severity (measured using the Charlson Comorbidity Index). These differences remained statistically significant after adjusting for demographic and other clinical differences.


CONCLUSIONS
Depression is associated with significantly higher healthcare costs in FFS Medicare recipients with diabetes mellitus and CHF. Only a small proportion of the increased costs are spent on mental health specialty care.
Unützer
Jürgen
J
Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, Washington 98195, USA. unutzer@u.washington.edu
Schoenbaum
Michael
M
Katon
Wayne J
WJ
Fan
Ming-Yu
MY
Pincus
Harold A
HA
Hogan
Diane
D
Taylor
Jennifer
J
D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000191:economics*; D003924:Diabetes Mellitus, Type 2 / Q000191:economics*; D003953:Diagnosis-Related Groups / Q000191:economics; D018588:Fee-for-Service Plans / Q000191:economics*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000191:economics*; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D008297:Male; D008329:Managed Care Programs / Q000191:economics; D006278:Medicare / Q000191:economics*; D008605:Mental Health Services / Q000191:economics; D014481:United States