Recovery from depression predicts lower health services costs

To examine the association between outcome of acute-phase depression treatment and subsequent health services costs.

Data from 9 longitudinal studies of patients starting depression treatment were used to examine the relationship between outcome of acute-phase treatment and health services costs over the subsequent 6 months. All studies were 2- to 4-year studies conducted between the years 1991 and 2004. Assessment of diagnosis was done using the Inventory of Depressive Symptoms or the Structured Clinical Interview for DSM-IV. Clinical outcomes were assessed by structured telephone interviews using the Hamilton Rating Scale for Depression or a 20-item depression scale extracted from the Hopkins Symptom Checklist. Costs were assessed using health plan accounting records.

Of 1814 patients entering treatment and meeting criteria for major depressive episode, 29% had persistent major depression 3 to 4 months later, 37% were improved but did not meet criteria for remission, and 34% achieved remission of depression. Those with persistent depression had higher baseline depression scores and higher health services costs before beginning treatment. After adjustment for baseline differences, mean health services costs over the 6 months following acute-phase treatment were 2012 dollars (95% CI = 1832 dollars to 2210 dollars) for those achieving remission, 2571 dollars (95% CI = 2350 dollars to 2812 dollars) for those improved but not remitted, and 3094 dollars(95% CI = 2802 dollars to 3416 dollars) for those with persistent major depression. Average costs for depression treatment (antidepressant prescriptions, outpatient visits, and mental health inpatient care) ranged from 429 dollars in the full remission group to 585 dollars in the persistent depression group.

Among patients treated for depression in community practice, only one third reached full remission after acute-phase treatment. Compared with persistent depression, remission is associated with significantly lower subsequent utilization and costs across the full range of mental health and general medical services.