ASSOCIATION OF SYMPTOMS OF DEPRESSION WITH DIAGNOSTIC-TEST CHARGES AMONG OLDER ADULTS

Background: Previous studies have documented greater use of health ser vices by depressed persons and have postulated that health care costs could be reduced overall through better recognition and treatment of d epression. Objective: To determine whether a greater burden of medical illness contributes to excess charges for diagnostic tests among olde r adults with symptoms of depression. Design: Prospective cohort study . Setting: A primary care group practice at an academic institution. P atients: 3767 patients 60 years of age and older who completed testing on the Centers for Epidemiologic Studies Depression Scale (CES-D) dur ing routine office visits. Measurements: Charges for all inpatient and ambulatory diagnostic testing for 2 years, including clinical patholo gy, diagnostic imaging, and special procedures; number of visits to th e ambulatory care center or emergency department; and number of hospit alizations. The Ambulatory Care Group case-mix approach, which is base d on ambulatory diagnoses, was used as a measure of health status and expected resource consumption. Results: Patients with symptoms of depr ession (CES-D scores greater than or equal to 16) were significantly y ounger (66.6 compared with 68.1 years; P < 0.001), more likely to be w hite (50.5% compared with 33.9%; P = 0.001), and more likely to be fem ale (75.8% compared with 67.6%; P = 0.001) than were those without the se symptoms (CES-D scores < 16). They also had more nonpsychiatric com orbid conditions, had more visits to the ambulatory care center (9.2 c ompared with 7.8; P < 0.001), were more likely to use the emergency de partment (52.3% compared with 40%; P = 0.001), were more likely to be hospitalized (22.4% compared with 17%; P = 0.002), and had greater med ian total diagnostic test charges for a period of 1 year ($583 compare d with $387; P< 0.001). The difference in charges, most of which were clinical pathology charges (54.2%), persisted into the second year. Am bulatory Care Group assignment was independently associated with diagn ostic test charges. The CES-D summary score was not independently asso ciated with diagnostic test charges when controlling for Ambulatory Ca re Group assignment. Conclusions: Patients with symptoms of depression accrue greater average diagnostic test charges. However, these data s uggest that such patients also have a greater burden of comorbid nonps ychiatric illness. Efforts to improve outcome and decrease cost for pa tients who have late-life depression must target interventions to impr ove the care of psychiatric and medical illness concurrently.