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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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