Contingencies Online - July/August 2012

tradecraft STEVE MELEK AND MICHAEL HALFORD

Measuring the Cost of Undiagnosed Depression

DEPRESSION AFFECTS AS MANY AS 9. 5 percent of all Americans, but only about one-third of those affected seek treatment, according to the National Institutes of Health. A 2005 study found that in 2004 no more than 33 percent of insureds with major depressive disorder and 37 percent of insureds with dysthymia (chronic depression) reported receiving treatment during that same time period from a mental health specialist.

The health care, employer, and societal costs of depression, sadly, are considerable. Based on 2000 data, the total annual cost of depression was estimated to be $83.1 billion, with $26.1 billion ( 31 percent) being spent on medical costs, $5.4 billion ( 7 percent) related to suicide (death) costs, and $51.5 billion associated with workplace expenses, including absences and loss of productivity.

Despite its high cost and prevalence, depression often goes undiagnosed or isn’t diagnosed in a timely manner. Results from a survey conducted between 2001 and 2003 show that the median delay from the onset of depression to the beginning of treatment was estimated to be eight years for major depression and seven years for dysthymia. While the post-diagnosis costs of depression have been studied widely (including research we completed on the high costs of insureds with co-morbid chronic medical conditions and depression) the literature isn’t as robust on the costs for health care and absence from work during the period between the initial onset of the disease and its subsequent diagnosis. A better picture of those costs can point to potential areas for savings in the realm of behavioral health care.

Hidden Costs

To estimate the cost differences of people with undiagnosed depression , we studied the excess health care and work-absence costs during the two-year period leading up to an initial diagnosis. Our study relied upon data from MarketScan, a large national database containing multiple years of sequential health care and absence-from-work data. We used a matched-case control study to quantify the differences in health care and absenteeism costs between a set of insureds who were diagnosed with depression and a matched set of insureds who were similar in terms of demographics and health status but for whom we saw no evidence of treated depression in the claims database. We focused on total inpatient, outpatient, and pharmacy costs as well as on hours of absence from work.

The results are presented separately
depending on whether the insureds first
were identified with depression based on
antidepressant use or through an ICD- 9
(International Statistical Classification of
Diseases and Related Health Problems)
depression diagnosis code. Antidepres-
sant use indicates treatment was most
likely for depression (barring off-la-
bel uses). Depression diagnosis codes
indicate the presence of depression for
insureds who may or may not have re-
ceived treatment. We also separated the
results for those with a higher-than-av-
erage risk score (high-risk group) and
those with an average or lower-than-
average risk score (low-risk group). The
costs are presented by calendar quarter
and cover the two-year period leading up
to the date of depression diagnosis or the
beginning of treatment.

Note: In Figures 1 through 15, Quarter
1 refers to the first quarter in the two-
year study period prior to the diagnosis
of depression; Quarter 8 refers to
the quarter immediately prior to the
diagnosis of depression.
Sources for all figures:
Melek, S., Halford, M.

FIGURE 1

Cost Differences for People With Undiagnosed Depression by Quarter Prior to Diagnosis

Cost Category Quarter 1 Quarter 2 Quarter 3 Quarter 4 Quarter 5 Quarter 6 Quarter 7 Quarter 8 ExcessHealthCareCost $151.61 $167.37 $134.93 $138.05 $126.46 $111.37 $132.65 $528.60 ExcessAbsence-From-WorkCosts 160.47 170.68 147.90 246.23 305.64 275.75 314.15 274.34 TotalExcessCost 312.08 338.05 282.83 384.28 432.10 387.12 446.80 802.94