Depression treatment: The impact of treatment persistence on total healthcare costs

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Depression is a prevalent and costly disorder. Existing research has shown that many patients suffering
from behavioral health conditions, including depression, receive inadequate or no treatment for these
disorders. Inadequate treatment often occurs when patients discontinue their prescribed courses
of treatment. The purpose of this research report is to attempt to quantify the impact of depression
treatment persistence on post-treatment healthcare costs. Is persistent treatment associated with future
healthcare cost savings? In other words, do patients who receive more (and/or continue to receive)
depression treatment—whether through psychotherapy only, pharmacotherapy only, or a combination of
both therapies—have lower total healthcare cost growth post-treatment than those who received less (or
discontinued treatment)?
We conducted a study from a large national medical claims database to address the research questions
above. We selected treated depressed patients and placed them in different cohorts depending on
their treatment paths. After analyzing baseline clinical and demographic characteristics, we compared
the relative change in total healthcare cost from the pre-treatment period to the post-treatment period
by cohort.
For the population of all treated depressed patients, we found that the relationship between treatment
persistence and healthcare cost growth is mixed. In some comparisons, persistently treated members
experienced lower healthcare cost growth; in other cases, they experienced higher healthcare cost
growth. However, when we focused only on patients with certain chronic comorbid medical conditions,
there is evidence that persistent treatment is associated with slower growth in total healthcare costs.

The entire cohort of members treated with persistent pharmacotherapy only had slightly lower post-
treatment cost growth than their nonpersistent counterparts. The opposite was true for the persistent

psychotherapy-only group—they had slightly higher post-treatment cost growth than the nonpersistent
psychotherapy group. Interestingly, the combination cohort (psycho- and pharmacotherapy) treatment
results depended on which therapy was persistent. When the prescription drug treatments were
persistent, lower post-treatment cost growth was observed. When the psychotherapy was persistent,
higher post-treatment cost growth was observed.
The greatest reduction in the growth of post-treatment healthcare costs was observed when depression
was comorbid with chronic medical conditions and treatment was persistent. Cost growth reductions
were observed for these conditions and treatments:
Persistent pharmacotherapy only: asthma, arthritis, diabetes, hypertension
Persistent psychotherapy only: asthma, arthritis, diabetes
Persistent combination treatment: asthma, arthritis, diabetes, hypertension
The results suggest that there is a relationship between persistent treatment for depression and future
healthcare cost trend reductions for certain treatment paths and patient cohorts. Additionally, our results
call into question whether persistent treatment will always lead to such healthcare cost trend reductions.
For example, persistent treatment that does not result in clinical improvement, for whatever reason, may
not reduce healthcare costs. The quality of treatment (for example, effectiveness of psychotherapy or
selection of the right dosage of the right antidepressant for a given patient) is important as well. We
conclude with a discussion of the results and of suggestions for future research on this topic.

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