title: Covariates of depression and high utilizers of healthcare: Impact on resource use and costs.
abstract: To characterize healthcare costs, resource use, and treatment patterns of survey respondents with a history of depression who are high utilizers (HUds) of healthcare and to identify factors associated with high utilization.
  
  
  
  Adults with two or more depression diagnoses identified from the HealthCore Integrated Research Database were invited to participate in the CODE study, which links survey data with 12-month retrospective claims data. Patient surveys provided data on demographics, general health, and symptoms and/or comorbidities associated with depression. Similar clinical conditions also were identified from the medical claims. Factors associated with high utilization were identified using logistic regression models.
  
  
  
  Of 3132 survey respondents, 1921 were included, 193 of whom were HUds (defined as those who incurred the top 10% of total all-cause costs in the preceding 12months). Mean total annual healthcare costs were eightfold greater for HUds than for non-HUds ($US56,145 vs. $US6,954; p<.0001). HUds incurred more inpatient encounters (p<.0001) and emergency department (p=.01) and physician office visits (p<.0001). Similar findings were observed for mental healthcare costs/resource use. HUds were prescribed twice as many medications (total mean: 16.86 vs. 8.32; psychotropic mean: 4.11 vs. 2.61; both p<.0001). HUds reported higher levels of depression severity, fatigue, sleep difficulties, pain, high alcohol consumption, and anxiety. Predictors of becoming a HUd included substance use, obesity, cardiovascular disease, comorbidity severity, psychiatric conditions other than depression, and pain.
  
  
  
  Focusing on pain, substance use, and psychiatric conditions beyond depression may be effective approaches to reducing high costs in patients with depression.
authors.affiliation: Eli Lilly and Company, Indianapolis, IN, United States. Electronic address: rlrobinson@lilly.com.
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Robinson
authors.affiliation: HealthCore, Inc., Wilmington, DE, United States.
authors.forename: Michael
authors.initials: M
authors.lastname: Grabner
authors.affiliation: CTI Clinical Trial and Consulting Services, Cincinnati, OH, United States.
authors.forename: Swetha Rao
authors.initials: SR
authors.lastname: Palli
authors.affiliation: Eli Lilly and Company, Indianapolis, IN, United States.
authors.forename: Douglas
authors.initials: D
authors.lastname: Faries
authors.affiliation: HealthCore, Inc., Wilmington, DE, United States.
authors.forename: Judith J
authors.initials: JJ
authors.lastname: Stephenson
mesh_terms: D000328:Adult; D000368:Aged; D016208:Databases, Factual; D003863:Depression / Q000191:economics* / Q000523:psychology* / Q000628:therapy; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data*; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012189:Retrospective Studies; D014481:United States
keywords: Alcohol use; Anxiety; Costs; Depression; Fatigue; Pain