Sambamoorthi U (REAP, E Orange), Shen C
(REAP, E Orange), Kashner M
(Columbia University), Olfson M
(Veterans Affairs Medical Center, Southwestern University,Dallas), Pogach L
(REAP, E Orange), Banerjea R
(REAP, E Orange)
This paper estimates the additional total, inpatient, outpatient, and pharmaceutical expenditures associated with incident and prevalent depression among veterans with diagnosed diabetes and depression, after controlling for demographic, socio-economic, and health status characteristics.
Retrospective analysis of 521,578 Veterans Health Administration (VHA) clinic users with diabetes as of fiscal year 2000. Depression was identified using ICD-9-CM codes of 296.2, 296.3, 309.1, 300.4, and 311. Among VHA users with depression we distinguished between prior and incident depression in fiscal year 2000. Incident episode of depression was identified using 120-day (4-month) “negative diagnosis or medication history” on or before the first observed depression diagnosis date in FY 2000. VHA inpatient and outpatient expenditures were derived from average expenditure estimates of the Health Economics Resource Center average cost files. Pharmaceutical expenditures were derived from Pharmacy Benefit Management files. Quantile regressions and two part models of expenditures using generalized linear models were used.
Among VHA users with diabetes, 4.6% (N = 23,922) had a prevalent depression and 8.6% (N = 44,636) had an incident episode in fiscal year 2000. The average VHA expenditures were $12,211 for prevalent, $10,401 for incident, and $5,689 for no depression. After controlling for other characteristics, veterans with no depression had lower expenditures ($-446) compared to those with prevalent depression. No differences in VHA expenditures between those with incident and prevalent depression were observed. Quantile regression estimates revealed that depressive disorders are not associated with additional expenditures at every point of the expenditures distribution.
Average healthcare expenditures for veterans with depression are twice as high as of those without depression. Because a majority of veterans with diabetes also use Medicare, our cost estimates are substantially biased and probably underestimated due to the exclusion of the Medicare paid amount.
Cost-saving efforts need to focus on treating depression as evidence in the literature indicates the cost-effectiveness of depression treatment in individuals with diabetes.