Mariam Khayretdinova August 24, 2021 - 4 min read
The Cost of Treating Depression
Depression is a costly disease, particularly in terms of quality of life years lost to patients, lost productivity translating to dollar amounts for employers, and treatment associated costs. While studies do provide some estimates of cost, many of these are retrospective in nature and likely to underestimate current costs given inflation and other factors such as increases in medication prices that contribute to the rising cost of healthcare.
For example, in 2020, overall increases in the price of prescription drugs outpaced inflation of the U.S. economy by over 200% (Avery, 2021).
This trend has been mirrored over the past decade, with drug prices increasing about 300% more than inflation from 2007-2018 (Lagasse, 2020). Why do drug prices matter? Well, drugs make up a significant portion of total outpatient treatment cost, which influences whether patients will follow through with treatment. In fact, physicians have identified medication cost as the single largest factor in predicting adherence to treatment (Morse, 2019). Further, nearly 30% of patients report not adhering to the medications prescribed for treatment due to cost (Kirzinger et a., 2019). When it comes to depression, lack of adherence to daily preventative measures overseen by a primary care provider may result in patients seeking or unintentionally receiving treatment in other, more costly settings, such as emergency departments.
This pattern is evident with patients who are “super-utilizers” of healthcare resources, defined as patients whose consumption of services places them in the 10% of total healthcare expenditures (Robinson et al., 2016) Robinson and colleagues compared high-utilizer depressed patients with more typical utilizers of healthcare resources who had also received a depression diagnosis. Researchers found that patients in the high utilization group reported greater depression severity and spent more time in the emergency department, hospital, and their physician’s office. High-utilizers were also prescribed about twice as many medications–both psychotropic and non-psychotropic (Robinson et al., 2016). Prescribing more medications likely does not translate to real world benefits for patients, nor does it improve their quality of life. In fact, more prescriptions increases cost of care and may actually present a barrier to treatment, making it difficult for the patient to both manage and afford their medications.
As might be expected, research has demonstrated that the severity of depression directly corresponds to cost. A study conducted in 2019, based on 2013 rates of inflation found that severity of depression, as measured by PHQ-9 scores, correlated with costs associated with depression (Chow et al., 2019). The researchers divided costs into two main categories, direct and indirect. Direct costs included expenditures such as outpatient treatment, hospitalization, and emergency department visits. Indirect costs included expenditures not directly related to depression treatment, such as absenteeism from work, or attending work while having difficulty with normal levels of productivity and functioning due to depression. This study found that on average, yearly direct costs of depression treatment ranged from $6053 for mild depression (PHQ-9 = 0-4), $7604 for moderate depression (PHQ-9 = 5-14), and $10,611 for severe depression (PHQ-9 = 15-27). Indirect costs were higher than direct costs for all categories except mild depression (Chow et al., 2019). Studies such as this point to the need to find effective ways to more permanently reduce symptomatology in order to decrease the cost of depression treatment over time.
The numbers discussed thus far have occurred at the level of the group or the population. To make the economic impact of depression easier to visualize, it may prove helpful to discuss costs at the level of the individual. In an interview of six people living and working in the U.S., monthly costs of managing their depressive symptoms were found to have a very wide range (Haelle, 2016). Recurring costs started at the low end for one individual, at $10 for medication after a copay, to the high end of $1700 for another person. These costs, in addition to medication and psychotherapy, were the result of also incorporating lifestyle factors such as a high quality diet, supplements, gym and fitness classes, and aromatherapy (Haelle, 2016).
In reality, medication and psychotherapy alone are likely insufficient in managing depression without accompanying lifestyle changes. It is also important to keep in mind that the true cost of depression is much higher than the numbers presented, as health insurance coverage was factored into these dollar amounts. In short, depression is a costly disease to manage, and costs will only continue to rise as depression trends upward, with young people disproportionately driving this increase (Weinberger et al., 2017).
Avery, T. (2021, June 8). Prescription drug prices increased twice the inflation rate of US economy in 2020, AARP report finds. USA Today. https://www.usatoday.com/story/news/health/2021/06/08/aarp-prescription-drug-price-us-inflation-2020/7601608002/
Chow, W., Doane, M. J., Sheehan, J., Alpha, L., & Le, H. (2019). Economic burden among patients with major depressive disorder: An analysis of healthcare resource use, work productivity, and direct and indirect costs of depression severity. American Journal of Managed Care. https://www.ajmc.com/view/economic-burden-mdd
Haelle, T. (2016, January 29). The real monthly cost of depression: Six people reveal how much they spend to treat their depression, how they save money on medications, and more. Everyday Health. https://www.everydayhealth.com/news/real-monthly-cost-depression/
Kirzinger, A., Lopes, L., Wu, B., & Brodie, M. (2019). KFF health tracking poll – February 2019: Prescription drugs. https://www.kff.org/health-reform/poll-finding/kff-health-tracking-poll-february-2019-prescription-drugs/
Lagasse, J. (2020, March 4). Drug prices rose three times faster than inflation over the last decade, even after discounts. Healthcare Finance. https://www.healthcarefinancenews.com/news/drug-prices-rose-three-times-faster-inflation-over-last-decade-even-after-discounts
Morse, S. (2019, March 20). High price of drugs is biggest issue in prescription adherence, physicians say. Healthcare Finance. https://www.healthcarefinancenews.com/news/high-price-drugs-biggest-issue-prescription-adherence-physicians-say
Robinson, R. L., Grabner, M., Palli, S. R., Faries, D., & Stephenson, J. J. (2016). Covariates of depression and high utilizers of healthcare: Impact on resource use and costs. Journal of Psychosomatic Research, 85, 35–43. https://doi.org/10.1016/j.jpsychores.2016.04.002
Weinberger, A. H., Gbedemah, M., Martinez, A. M., Nash, D., Galea, S., & Goodwin, R. D. (2018). Trends in depression prevalence in the USA from 2005 to 2015: Widening disparities in vulnerable groups. Psychological Medicine, 48(8), 1308–1315. https://doi.org/10.1017/S0033291717002781
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