title: Impact of mental health visits on healthcare cost in patients with diabetes and comorbid mental health disorders.
abstract: OBJECTIVE
  To assess the impact of mental health visits (MHV) on the cost of care for Veterans with diabetes and comorbid mental health conditions.
  
  
  METHODS
  A national cohort of 120,852 Veterans with diabetes and at least one mental health diagnosis (i.e., substance abuse, depression or psychoses) in 2002 was followed through 2006. Outcomes were pharmacy, inpatient and outpatient costs in 2012 dollars.
  
  
  RESULTS
  Least-square covariate adjusted estimates from the joint model of total VA costs of the number of MHV using December 31, 2012 value dollars indicate that relative to those with fewer MHV, those with 3+ MHV had the lowest mean inpatient cost ($21,406), but the highest mean outpatient and pharmacy cost ($9,727 and $2,015, respectively). If all Veterans who received zero MHV actually received 3+ MHV, we estimate through simulated scenarios that between $32,272,329 and $181,460,247 in inpatient costs would be saved. However, these savings would be offset by additional expenditures of between $1,166,017,547 and $1,166,224,787 in outpatient costs and between $151,604,683 and $161,439,632 in pharmacy costs.
  
  
  CONCLUSIONS
  Among Veterans with diabetes and comorbid mental disorders having three or more mental health visits is associated with marginally decreased inpatient cost, but these potential savings seem to be offset by increased outpatient and pharmacy costs.
authors.affiliation: Center for Health Disparities Research, Division of General Internal Medicine, Medical University of South Carolina, Charleston, South Carolina, United States of America.
authors.forename: Leonard E
authors.initials: LE
authors.lastname: Egede
authors.affiliation: Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina, United States of America; Division of Biostatistics & Epidemiology, Medical University of South Carolina, Charleston, South Carolina, United States of America.
authors.forename: Mulugeta
authors.initials: M
authors.lastname: Gebregziabher
authors.affiliation: Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina, United States of America; Center for Health Disparities Research, Division of General Internal Medicine, Medical University of South Carolina, Charleston, South Carolina, United States of America.
authors.forename: Yumin
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina, United States of America; Center for Health Disparities Research, Division of General Internal Medicine, Medical University of South Carolina, Charleston, South Carolina, United States of America.
authors.forename: Clara E
authors.initials: CE
authors.lastname: Dismuke
authors.affiliation: Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina, United States of America; Center for Health Disparities Research, Division of General Internal Medicine, Medical University of South Carolina, Charleston, South Carolina, United States of America.
authors.forename: Rebekah J
authors.initials: RJ
authors.lastname: Walker
authors.affiliation: Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina, United States of America; Division of Biostatistics & Epidemiology, Medical University of South Carolina, Charleston, South Carolina, United States of America.
authors.forename: Kelly J
authors.initials: KJ
authors.lastname: Hunt
authors.affiliation: Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina, United States of America; Center for Health Disparities Research, Division of General Internal Medicine, Medical University of South Carolina, Charleston, South Carolina, United States of America.
authors.forename: R Neal
authors.initials: RN
authors.lastname: Axon
mesh_terms: D000368:Aged; D003920:Diabetes Mellitus / Q000191:economics*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000191:economics*; D008603:Mental Health / Q000191:economics*; D008875:Middle Aged
references.citation: Schizophr Res. 2008 Apr;101(1-3):256-65
references.pmid: 18353616
references.citation: Psychiatr Serv. 2012 Apr;63(4):383-5
references.pmid: 22476305
references.citation: Am J Psychiatry. 2010 Feb;167(2):151-9
references.pmid: 20008945
references.citation: Prev Chronic Dis. 2012;9:E51
references.pmid: 22300871
references.citation: Schizophr Bull. 2010 Mar;36(2):428-35
references.pmid: 18718883
references.citation: Diabetes Res Clin Pract. 2010 Mar;87(3):302-12
references.pmid: 20181405
references.citation: J Psychiatr Ment Health Nurs. 2012 Dec;19(10):891-902
references.pmid: 22314180
references.citation: Diabetes Care. 2012 Dec;35(12):2533-9
references.pmid: 22912429
references.citation: Curr Psychiatry Rep. 2012 Feb;14(1):15-22
references.pmid: 22002804
references.citation: Diabetes Care. 2008 Mar;31(3):596-615
references.pmid: 18308683
references.citation: Diabetes Care. 2004 May;27 Suppl 2:B10-21
references.pmid: 15113777
references.citation: J Clin Psychiatry. 2010 Jul;71(7):855-63
references.pmid: 20122374
references.citation: Am J Psychiatry. 2004 Aug;161(8):1471-6
references.pmid: 15285975
references.citation: J Telemed Telecare. 2007;13(3):142-7
references.pmid: 17519056
references.citation: Psychiatr Serv. 2004 Aug;55(8):892-900
references.pmid: 15292539
references.citation: Cochrane Database Syst Rev. 2017 Jan 06;1:CD007906
references.pmid: 28067944
references.citation: Prim Care Diabetes. 2012 Jul;6(2):149-56
references.pmid: 22047940
references.citation: Diabetologia. 2010 Dec;53(12):2470-9
references.pmid: 20700575
references.citation: J Rural Health. 2010 Fall;26(4):301-9
references.pmid: 21029164
references.citation: Diabetes Care. 2011 Apr;34(4):938-43
references.pmid: 21335370
references.citation: Manag Care Interface. 2006 Mar;19(3):39-46
references.pmid: 16583789
references.citation: Adm Policy Ment Health. 2009 Jul;36(4):255-64
references.pmid: 19280333
references.citation: Med Care. 2006 Apr;44(4):334-42
references.pmid: 16565634
references.citation: Diabetes Care. 2002 Mar;25(3):464-70
references.pmid: 11874931
references.citation: Psychosomatics. 2008 Mar-Apr;49(2):109-14
references.pmid: 18354063
references.citation: Diabet Med. 2008 Sep;25(9):1096-101
references.pmid: 19183314