Health care expenditures associated with depression in adults with cancer

Abstract

Background The rates of depression in adults with cancer have been reported as high as 38%–58%. How depression affects overall health care expenditures in individuals with cancer is an under-researched area. Objective To estimate excess average total health care expenditures associated with depression in adults with cancer by comparing those with and without depression after controlling for demographic, socioeconomic, access to care, and other health status variables. Methods Cross-sectional data on 4,766 adult survivors of cancer from 2006–2009 of the nationally representative household survey, Medical Expenditure Panel Survey (MEPS), were used. The patients were older than 21 years. Cancer and depression were identified from the patients’ medical conditions files. Dependent variables consisted of total, inpatient, outpatient, emergency department, prescription drugs, and other expenditures. Ordinary least square (OLS) on logged dollars and generalized linear models with log-link function were performed. All analyses (SAS 9.3 and STATA12) accounted for the complex survey design of the MEPS. Results Overall, 14% of individuals with cancer reported having depression. In those with cancer and depression, the average annual health care expenditures were $18,401 compared with $12,091 in those without depression. After adjusting for demographic, socio-economic, access to care, and other health status variables, those with depression had about 31.7% greater total expenditures compared with those without depression. Total, outpatient, and prescription expenditures were higher in individuals with depression than in those without depression. Individuals with cancer and depression were significantly more likely to use emergency departments (adjusted odds ratio, 1.46) compared with their counterparts without depression. Limitations Cancer patients who died during the reporting year were excluded. The financial burden of depression may have been underestimated because the costs of end-of-life care are high. The burden for each cancer type was not analyzed because of the small sample size. Conclusion In adults with cancer, those with depression had higher health care utilization and expenditures compared with those without depression.

The impact of chronic conditions on the economic burden of cancer survivorship: a systematic review

“…Four studies provided estimates of the additional medical costs attributable to individual chronic conditions (Table 2) [21,29,31,34]. Among cancer survivors enrolled in Medicaid in three states (Georgia, Maine, or Illinois), the additional total cost of care over a 6-month period ranged from $3418 to $4385 for cardiac conditions; $5040 to $8155 for respiratory conditions; and $7483 to $7714 for diabetes (all US$ 2003) [21].…”

“…Among elderly renal cell carcinoma cancer survivors, the additional 1-year Medicare costs of care attributed to hyperlipidemia and anemia were $2745 and $2167 (US$ 2005), respectively [31]. Within a nationally representative sample, the additional annual cost of psychosocial distress was estimated to be $4431 (US$ 2010) [29] and $6310 (US$ 2009) for depression [34] among cancer survivors. Meanwhile, among cancer survivors enrolled in Medicaid in Georgia, Maine, or Illinois [21], the estimated additional costs of mental health disorders (including schizophrenic disorders, episodic mood disorders, delusional disorders, anxiety/personality disorders, and depressive disorders) was $8004 to $11,009 over a 6-month period (US$ 2003) [21].…”

“…Two studies provided estimates of the additional medical costs associated with individual chronic conditions by service type [21,34]. Hospital costs accounted for the largest additional per person 6-month medical costs associated with cardiac conditions, respiratory conditions, diabetes, and mental health [21].…”

“…Mental health had the highest hospital ($6883), long-term care ($2214), and ambulatory care costs ($1198) compared to other conditions (in US$ 2003) [21]. The added 1-year costs per cancer survivor with depression were highest in the hospital and ambulatory care setting [34]. …”

“…Our search identified 2,317 studies of which 2,268 were excluded based on abstract review, leaving 49 articles for full-text review. Of the 49 articles, 37 did not include cost information among cancer survivors by comorbidity, and 12 met all inclusion criteria (Figure 1) [21,24–34]. No additional articles were identified through manual reference list search.…”