Recovery from depression predicts lower health services costs

Objective: To examine the association between outcome of acute-phase depression treatment and subsequent health services costs. Method: 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. Results: 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 (95% CI= $1832 to $2210) for those achieving remission, $2571 (95% CI = $2350 to $2812) for those improved but not remitted, and $3094 (95% CI = $2802 to $3416) for those with persistent major depression. Average costs for depression treatment (antidepressant prescriptions, outpatient visits, and mental health inpatient care) ranged from $429 in the full remission group to $585 in the persistent depression group. Conclusions: 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.