Mental Health
Association Between Depression Severity and Total Cost of Care: Findings From a Large, 2-year, Claims-Based, Retrospective Study in the USA Amber Shergill* Amber Shergill Tyson Barrett Andrey A. Popkov Michael Donohue Ryan Anderson Brad Karlin
Despite the substantial impact of depression on individuals and healthcare utilization, little is known about the specific relationship between depression severity and total cost of care (TCC). The current study aimed to evaluate the association between depression severity and TCC and how changes in depression severity affect changes in those costs.
Retrospective cohort analysis of insured individuals in the US was conducted using insurance claims data and data from electronic health records between January 1, 2019 and December 31, 2020. Information in the claims data were linked with the electronic medical records. Inclusion criteria comprised insured individuals with coverage during 2019 or 2020, aged one year or older, and stratified into either minimal, mild, moderate, or severe categories of depression in at least one year of the study. The main outcome was TCC per member per month (PMPM) evaluated across the two-year study period.
Across 2019 and 2020, 744,854 members met inclusion criteria. A total of 369,460 members were studied across both years. Greater depression severity was associated with higher TCC across both years (rho=0·156; 0·154, p<;0·001). Unchanged depression severity was associated with limited change (+$52-$79) in TCC from 2019 to 2020. Decrease in depression severity was associated with an average $41 reduction in PMPM spend (95% CI=[$5, $78], p=0·028), whereas increase in depression severity was associated with an average $608 increase in PMPM spend (95% CI=[$554, $661], p<;0·001).
Overall, greater depression severity was associated with higher total health care expenditures. Further, changes in depression severity over time were significantly associated with changes in TCC. Findings reveal significant financial opportunities associated with early identification and targeted, effective management of depression and changes in depression severity to reduce expenditures and inform allocation of resources.
