HEALTH-CARE COSTS OF PRIMARY-CARE PATIENTS WITH RECOGNIZED DEPRESSION

Background: While an extensive literature documents the influence of d epression on general medical services utilization, estimates of the ec onomic burden of depression have focused on the direct costs of depres sion treatment. Higher use of general medical services may contribute significantly to the true cost of depressive illness. Methods: Compute rized record systems of a large staff-model health maintenance organiz ation (HMO) were used to identify consecutive primary care patients wi th visit diagnoses of depression (n=6257) and a comparison sample of p rimary care patients with no depression diagnosis (n=6257). The HMO ac counting records were used to compare components of health care costs. Results: Patients diagnosed as depressed had higher annual health car e costs ($4246 vs $2371, P<.001) and higher costs for every category o f care leg, primary care, medical specialty, medical inpatient, pharma cy, laboratory). Similar cost differences were observed for each of th e subgroups examined (patients treated with antidepressants, those not treated with antidepressants, and those diagnosed at routine physical examination visits). Pharmacy records indicated greater chronic medic al illness in the diagnosed depression group, but large cost differenc es remained after adjustment ($3971 vs $2644). Twofold cost difference s persisted for at least 12 months after initiation of treatment. Conc lusions: Diagnosis of depression is associated with a generalized incr ease in use of health services that is only partially explained hy com orbid medical conditions. In the primary care sector, this greater med ical utilization exceeds direct treatment costs for depression. The pe rsistence of utilization differences suggests that recognition and ini tiation of treatment alone are not adequate to reduce utilization diff erences.