Inpatient treatment of depression and associated hospital charges

We evaluated inpatient treatment of depression, prescribing patterns for antidepressants, and associated hospital charges.

We reviewed administrative data of the UCLA Neuropsychiatric Hospital between July 1994 and July 1997 for all 1698 hospitalizations for mood disorders. We evaluated drug utilization patterns and hospital charges by analysis of variance and multiple regression, and by stratifying on diagnosis, severity, age, and other factors.

Length of stay was the major contributor to total charges, which included room charges and charges for services, procedures, supplies, and tests. The selective serotonin reuptake inhibitors (SSRIs) were prescribed most often (to 47% of patients), followed by the atypicals (heterocyclics, 12%), the tricyclics (TCAs, 7%), venlafaxine (7%) and the monoamine oxidase inhibitors (MAOIs, < 1%). The atypicals were given to the oldest patients. After controlling for length of stay, patient age, genders and comorbidity, the atypicals were associated with the highest total inpatient charges: $2000 more than MAOIs, $600 more than SSRIs, and $600 more than venlafaxine. Higher charges were the result of more expensive procedures, especially ECT.

The SSRIs were the most commonly used antidepressant. Charges for antidepressant medications contributed only 0.5% of total inpatient charges. Patients receiving atypicals had among the highest total charges, partly because of the higher use of ECT. They may represent a more severely depressed group who have not responded to other antidepressants.