Actionable Insights Newsletter

Translating research to power whole health

Issue 6    |    August 2023

"No treatment” can be more costly than “any treatment” for patients with depression

Enabling faster access to psychotherapy, including via telehealth, is one possible solution to improving symptoms while generating cost savings.

Enterprise Analytics Core domain(s): Behavioral health, health equity/social determinants of health, cost of care, quality of care

Summary

Background
In the US, depression is one of the most prevalent mental health disorders, with a lifetime risk of 30% (Kessler 2012). Few studies have examined the use of nonpharmacologic treatments, or treatments that do not involve medications, and their association with healthcare resource utilization (HCRU) and cost.

Objective
To describe prevalence and associations between patient/provider characteristics and treatment type, and characterize HCRU and cost by treatment type, for patients with newly diagnosed major depressive disorder.

Methods
This retrospective, observational study used claims data to examine commercially insured US patients aged 18-62 years with newly diagnosed depression between January 2017 and September 2019. Patients with other diagnosed mental health disorders were excluded. We observed patients for two years after their initial diagnosis, described their demographic and clinical characteristics, treatment patterns, and costs, and estimated associations between patient characteristics and selected outcomes.

Results

• In total, 12,657 patients were included (mean age: 36 years; 60% female). Within two years after diagnosis, 34% of patients received medication only, 25% received psychotherapy only, 28% received a combination of both, and 13% received no treatment.
  
• Patients treated with both medication and psychotherapy were more likely to improve their depression symptoms and those with no treatment had the highest HCRU (inpatient and ER visits) and costs (Figure 1).
• Approximately 13% of diagnosed patients received no claims-reported treatment at all. Among patients with available severity assessments, most (76%) had no improvement in depression severity.
• Age, sex, geographic region, social determinants of health, and other factors impacted choice of treatment and improvements in severity. For example, patients who lived in neighborhoods of high socioeconomic status were more likely to improve severity than those living in neighborhoods of low status.

Key takeaways