Background: Depression and myocardial infarction (MI) often coexist and has been associated with worse health outcomes. Evidence suggest that hospital visits and prescription medications account for majority of the healthcare expenditure, even among MI patients and this is expected to increase over the next decade. However, little is known of the excessive burden of depression on health resource utilization and healthcare expenditure among patients with MI. Using a nationally representative sample of the US adult population, we compare healthcare expenditure(total and out-of-pocket) and health resource utilization(emergency room visits and hospitalizations) among MI patients without the diagnosis of depression with depressed MI patients.
Methods: We used data from the 2006-2015 Medical Expenditure Panel Survey (MEPS) for this study. We included adults ≥18 years with a diagnosis of MI (ICD9 code 410 and/or self-reported) and stratified these individuals based on the presence of the diagnosis of Depression, identified by ICD9 code 311. We used the two-part econometric model to study cost data and regression models adjusted for sociodemographic characteristics and cardiovascular disease risk factors to compare health resource utilization between depressed and non-depressed MI patients.
Results: The study sample consisted of 6,702 individuals, representing 7.16m MI patients without the diagnosis of depression and 1,381 individuals representing 1.42m depressed MI patients (aged 65 ± 13 years, 63% male). Compared with non-depressed MI patients, MI patients with a diagnosis of depression had higher odds for hospitalizations [OR 1.54 (1.29, 1.83)] and emergency room visits [OR 1.43 (1.21, 1.69)], significantly greater mean annual expenditure as well as an estimated $4,381 ($2,553, $6,209) & $402 ($225, $579) higher annual overall and out-of-pocket healthcare expenditures respectively (Table).
Conclusion: Depression among MI patients is associated with a significant increase in annual healthcare expenditure and health resource utilization. As a quality improvement measure to increase healthcare efficiency, routine depression screening at follow up visits may be appropriate especially among these high risk population.