title: Impact of depression on health care utilization and costs among multimorbid patients--from the MultiCare Cohort Study.
abstract: OBJECTIVE
  The 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.
  
  
  METHODS
  This 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.
  
  
  RESULTS
  Prevalence 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.
  
  
  CONCLUSIONS
  Among 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.
authors.affiliation: Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Jens-Oliver
authors.initials: JO
authors.lastname: Bock
authors.affiliation: Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany.
authors.forename: Melanie
authors.initials: M
authors.lastname: Luppa
authors.affiliation: Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Brettschneider
authors.affiliation: Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany.
authors.forename: Steffi
authors.initials: S
authors.lastname: Riedel-Heller
authors.affiliation: Department of Psychiatry, Technical University of Munich, Munich, Germany.
authors.forename: Horst
authors.initials: H
authors.lastname: Bickel
authors.affiliation: Department of General Practice, University of Düsseldorf Medical Center, Düsseldorf, Germany.
authors.forename: Angela
authors.initials: A
authors.lastname: Fuchs
authors.affiliation: Department of General Practice, Jena University Hospital, Jena, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Gensichen
authors.affiliation: Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Maier
authors.affiliation: Institute of General Practice, Goethe-University Frankfurt am Main, Frankfurt am Main, Germany.
authors.forename: Karola
authors.initials: K
authors.lastname: Mergenthal
authors.affiliation: Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Ingmar
authors.initials: I
authors.lastname: Schäfer
authors.affiliation: Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schön
authors.affiliation: Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.
authors.forename: Siegfried
authors.initials: S
authors.lastname: Weyerer
authors.affiliation: Institute for Biometry, Hannover Medical School, Hannover, Germany.
authors.forename: Birgitt
authors.initials: B
authors.lastname: Wiese
authors.affiliation: Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Hendrik
authors.initials: H
authors.lastname: van den Bussche
authors.affiliation: Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Scherer
authors.affiliation: Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Hans-Helmut
authors.initials: HH
authors.lastname: König
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003863:Depression; D015577:Geriatric Assessment; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data*; D012307:Risk Factors