Key Events Drive Significant Portion of Association Between Depression, Healthcare Utilization and Cost

The evidence linking to depression, particularly major depressive disorder, and to healthcare utilization and higher spending is broad and deep.

But new research findings show that at least some of the spending could be reined if physicians and hospitals targeted some major clinical manifestations of major depressive disorder, such as suicide attempts and treatment failures.

The research, by corresponding author Amy Tung, PharmD, MS, of Allergan Inc., and colleagues, was scheduled to be presented at the Academy of Managed Care Pharmacy’s 2020 annual meeting. The in-person event was canceled because of the COVID-19 outbreak, but presentations and abstracts were presented instead and published as a supplement to the Academy's journal. You can see that supplement here and Tung's abstract is numbered F22.

Tung, who is the associate director of health economics and outcomes research at Allergan, and her colleagues looked at administrative healthcare claims from an unnamed large insurer. The investigators sifted through the data to identify patients between the ages of 18 and 64 who were diagnosed with major depressife disorder between 2012 and 2018 and were prescribed an antidepressant. A total of 29,335 patients were identified for the study.

The records of the cohort were then examined to calculate total healthcare resource use (HRU), and then the independent effect on HRU of events such as MDD-related emergency room (ER) visits, suicide attempts/ideation, severe mental health disorder, and treatment failure.

The analysis found, not surprisingly, that all of the key events were associated with higher levels of HRU, which was expressed in terms of visits to a healthcare facility (inpatient, outpatient, and ER).

The events with the greatest impact on average per-patient HRU were severe mental health disorders, which were associated with 10.25 HRU visits compared with 7.75 visits for those patients without severe mental health disorders. Hospitalization for major depressive disorder (9.39 vs. 7.76 visits), ER visits related to major depressive disorder (9.37 vs. 7.76 visits), suicidal ideation/attempt (9.27 vs. 7.75 visits), and the failure of at least two treatments (8.28 vs. 7.43 visits) were also found to be associated with HRU.

A similar effect was found when those HRU datawere translated into all-cause healthcare spending. The largest spending disparity came when patients had severe mental health disorders ($12,337 vs. $7,513) and hospitalization related to major depressive disorder ($12,156 vs. $7,499). Suicide ideation/attempt raised all-cause spending by nearly $3,000 ($10,496 vs. $7,499). ER visits and treatment failure similarly had notable, though, smaller impacts.

These finding come against a backdrop of a growing recognition of depression’s influence on healthcare utilization and spending. A study published last in the American Journal of Managed Care found that spending on major depressive disorder rose by 21.5% between 2005 and 2010. That study also showed that people with serious depression shoulder heavy economic burdens beyond healthcare spending, including more missed days of work and higher overall work productivity impairment. That study concluded that the more severe a patient’s depression, the higher the economic burden associated with that patient.

In their new analysis, Tung and colleagues argued that one important strategy to address the high HRU and spending associated with patients with major depressive disorder would be to better treat or prevent costly key events.

“New MDD therapies that treat patients in the ER or the hospital or prevent suicide attempt/ideation, severe mental health disorder, and treatment failure have the greatest potential to reduce overall MDD costs,” they concluded.