title: Healthcare Expenditures Associated with Depression Among Individuals with Osteoarthritis: Post-Regression Linear Decomposition Approach.
abstract: BACKGROUND
  Depression is common among individuals with osteoarthritis and leads to increased healthcare burden. The objective of this study was to examine excess total healthcare expenditures associated with depression among individuals with osteoarthritis in the US.
  
  
  METHODS
  Adults with self-reported osteoarthritis (n = 1881) were identified using data from the 2010 Medical Expenditure Panel Survey (MEPS). Among those with osteoarthritis, chi-square tests and ordinary least square regressions (OLS) were used to examine differences in healthcare expenditures between those with and without depression. Post-regression linear decomposition technique was used to estimate the relative contribution of different constructs of the Anderson's behavioral model, i.e., predisposing, enabling, need, personal healthcare practices, and external environment factors, to the excess expenditures associated with depression among individuals with osteoarthritis. All analysis accounted for the complex survey design of MEPS.
  
  
  RESULTS
  Depression coexisted among 20.6 % of adults with osteoarthritis. The average total healthcare expenditures were $13,684 among adults with depression compared to $9284 among those without depression. Multivariable OLS regression revealed that adults with depression had 38.8 % higher healthcare expenditures (p < 0.001) compared to those without depression. Post-regression linear decomposition analysis indicated that 50 % of differences in expenditures among adults with and without depression can be explained by differences in need factors.
  
  
  CONCLUSIONS
  Among individuals with coexisting osteoarthritis and depression, excess healthcare expenditures associated with depression were mainly due to comorbid anxiety, chronic conditions and poor health status. These expenditures may potentially be reduced by providing timely intervention for need factors or by providing care under a collaborative care model.
authors.affiliation: School of Pharmacy, Department of Pharmaceutical Systems and Policy, West Virginia University, Robert C. Byrd Health Sciences Center (North), Morgantown, WV, USA. pagarwal@hsc.wvu.edu.
authors.forename: Parul
authors.initials: P
authors.lastname: Agarwal
authors.affiliation: School of Pharmacy, Department of Pharmaceutical Systems and Policy, West Virginia University, Robert C. Byrd Health Sciences Center (North), Morgantown, WV, USA.
authors.forename: Usha
authors.initials: U
authors.lastname: Sambamoorthi
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003863:Depression / Q000191:economics* / Q000209:etiology; D003866:Depressive Disorder / Q000191:economics / Q000209:etiology; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017059:Models, Econometric; D010003:Osteoarthritis / Q000191:economics* / Q000523:psychology; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D014481:United States; D055815:Young Adult
keywords: Anderson model; decomposition; depression; expenditures; osteoarthritis