An investigation in the December issue of Archives of General Psychiatry, one of the JAMA/Archives journals reveals that over one decade, costs for Medicaid-enrolled patients suffering from depression has significantly increased, although only slight improvements have been noted in quality of care.

The investigators explain:

“During the 1980s and 1990s, the number of adults diagnosed with and treated for depression increased, and the modality of treatment shifted. The percentage of adults with depression who received antidepressants increased, and the percentage that received psychotherapy or were hospitalized for depression decreased.”

Catherine A. Fullerton, M.D., M.P.H., of Harvard Medical School and Cambridge Health Alliance, Boston, and her team conducted an investigation in order to assess changes in spending, quality of care and depression health service utilization from July 1996 to June 2006 by analyzing data from Medicaid claims in Florida. The researchers identified annual cohorts of adults aged between 18 to 64 years with depression from Medicaid claims data, who had one or more hospitalizations with a principal diagnosis of depression, or, who had made claims for depression as an outpatient on at least two different occasions.

The number of Medicaid-enrolled patients identified yearly varied from 8,970 to 13,265 with more individuals identified near the end of the investigation period. In total the researchers identified 56,805 patients with depression over the study period. They discovered that between July 1996 and June 2006, mental health care spending increased from a mean (average) $2,802 per patient to $3,610 per patient, a 29% increase. According to the researchers this increase seems to be due to a considerable increase in pharmacotherapy spending (110% increase), of which the majority was due to antipsychotic costs (949% increase).

The researchers found that during the 10 year study period:

  • the percentage of individuals with depression who received psychotherapy decreased from 56.6% to 37.5%
  • the percentage of hospitalized patients decreased from 9.1% to 5.1%
  • the use of antidepressants increased from 80.6% to 86.8%
  • the use of antipsychotics increased from 25.9% to 41.9%
  • the use of anxiety medications remained unchanged at 62.7% and 64.4%

However, the researchers also discovered alterations in quality of care were varied with antidepressant use improving slightly, psychotherapy utilization fluctuating, and follow-up visits decreasing.

They researchers conclude:

“In summary, during the 10-year period between 1996 and 2006, we found a substantial increase in spending for patients with depression, with minimal improvements in quality of care. Our findings underscore the importance of continued efforts to improve quality of care for individuals with depression, as well as the need to understand the efficacy and cost-effectiveness of using antipsychotics for the treatment of individuals with depression in the general community.”

Written by Grace Rattue