Recovery From Depression Predicts Lower Health Services Costs

Objective: To examine the association betweenoutcome of acute-phase depression treatment and subsequent healthservices costs.

Method: Data from 9 longitudinal studies ofpatients starting depression treatment were used to examine therelationship between outcome of acute-phase treatment and healthservices 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 ofDepressive Symptoms or the Structured Clinical Interview forDSM-IV. Clinical outcomes were assessed by structured telephoneinterviews using the Hamilton Rating Scale for Depression or a20-item depression scale extracted from the Hopkins SymptomChecklist. Costs were assessed using health plan accountingrecords.

Results: Of 1814 patients entering treatment andmeeting criteria for major depressive episode, 29% had persistentmajor depression 3 to 4 months later, 37% were improved but didnot meet criteria for remission, and 34% achieved remission ofdepression. Those with persistent depression had higher baselinedepression scores and higher health services costs beforebeginning treatment. After adjustment for baseline differences,mean health services costs over the 6 months followingacute-phase treatment were $2012 (95% CI = $1832 to $2210) forthose achieving remission, $2571 (95% CI = $2350 to $2812) forthose improved but not remitted, and $3094 (95% CI = $2802 to$3416) for those with persistent major depression. Average costsfor depression treatment (antidepressant prescriptions,outpatient visits, and mental health inpatient care) ranged from$429 in the full remission group to $585 in the persistentdepression group.

Conclusions: Among patients treated fordepression in community practice, only one third reached fullremission after acute-phase treatment. Compared with persistentdepression, remission is associated with significantly lowersubsequent utilization and costs across the full range of mentalhealth and general medical services.