The Effect on Healthcare Costs of Treating Comorbid Depressive Disorder with Chronic Disease
Objective: Does the cost of treating depressive disorder comorbidity inflate the cost of treating other chronic conditions? The answer is important both to payers and to those organizing health care delivery.
Methods: Results from the national Medical Expenditure Panel Survey of 2015 (N≈30,000) provided the data. We estimated costs from medical records and from the self-reported utilization of healthcare. Using the Mental Health Component Summary score of the 12-Item Short Form we estimated the level of depression. We used a general linear model to estimate costs with fixed effects for chronic disease (present or absent) and depression (highest third, middle third, lowest third). Physical health/functional status served as a covariate. We analyzed each of eight different chronic conditions (arthritis, chronic obstructive pulmonary disease, high cholesterol, cancer, diabetes, stroke, coronary heart disease, and asthma) separately.
Results: In each of these analyses, the presence or absence of the chronic condition had a strong impact on cost. In addition, being at the highest level of depression also had a significant impact on cost. However, the interaction between depression and chronic disease diagnoses tended to account for only a small amount of variation in cost.
Conclusion: The combination of depression and chronic disease diagnosis did not have a strong synergistic effect on the cost of medical care. An additive model provides a more parsimonious explanation of data from this national sample.
Robert M. Kaplan, PhD
Clinical Excellence Research Center, Stanford University School of Medicine
Robert M. Kaplan, PhD is research director at CERC. He has served as Chief Science Officer at the US Agency for Health Care Research and Quality (AHRQ) and Associate Director of the National Institutes of Health, where he led the behavioral and social sciences programs. He is also a Distinguished Emeritus Professor of Health Services and Medicine at UCLA, where he led the UCLA/RAND AHRQ health services training program and the UCLA/RAND CDC Prevention Research Center. He was Chair of the Department of Health Services from 2004 to 2009. From 1997 to 2004 he was Professor and Chair of the Department of Family and Preventive Medicine, at the University of California, San Diego. He is a past President of several organizations, including the American Psychological Association Division of Health Psychology, Section J of the American Association for the Advancement of Science (Pacific), the International Society for Quality of Life Research, the Society for Behavioral Medicine, and the Academy of Behavioral Medicine Research. Kaplan is a former Editor-in-Chief of Health Psychology and of the Annals of Behavioral Medicine. His 20 books and over 500 articles or chapters have been cited more than 30,000 times and the ISI includes him in the listing of the most cited authors in his field (defined as above the 99.5th percentile). Kaplan is an elected member of the National Academy of Medicine (formerly the Institute of Medicine). Dr. Kaplan is currently Regenstrief Distinguished Fellow at Purdue University and Adjunct Professor of Medicine at Stanford University.
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