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Depression-Related Costs in Heart Failure Care
Mark Sullivan, MD, PhD;
Greg Simon, MD, MPH;
John Spertus, MD, MPH;
Joan Russo, PhD
Arch Intern Med. 2002;162:1860-1866.
Background Behavioral factors may play a role in heart failure (HF) care costs
by increasing hospital readmission rates. This study sought to estimate the
effect of depression on health care costs for patients hospitalized for HF.
Methods A 3-year retrospective cohort study of a staff-model health maintenance
organization. Following a first hospitalization with a primary diagnosis of
HF, 1098 health maintenance organization patients were evaluated. Median annualized
health care costs for 3 depression groups were identified: (1) no depression
(n = 672; cost, $7474), (2) antidepressant prescription only (n = 312; cost,
$11 012), and (3) antidepressant prescription and depression diagnosis
recorded (n = 114; cost, $9550). Depression and HF status were determined
through diagnostic, laboratory, and pharmacy records. Actual utilization and
cost values were derived from administrative data.
Results After adjusting for age, sex, medical comorbidity, and length of stay
at index hospitalization (as proxy for HF severity), costs were 26% higher
in the antidepressant prescription only group and 29% higher in the antidepressant
prescription and depression diagnosis recorded group when compared with the
no depression group (both P<.001). Increased inpatient
and outpatient utilization contributed to the increased costs.
Conclusion Costs of care for patients hospitalized for HF are significantly higher
for patients with evidence of depression.
From the Department of Psychiatry and Behavioral Sciences, University
of Washington, Seattle (Drs Sullivan and Russo); the Center for Health Studies,
Group Health Cooperative, Seattle (Dr Simon); and the Mid-America Heart Institute,
University of Missouri–Kansas City (Dr Spertus).
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