Incremental Economic Burden of Depression in Ophthalmic Patients

• Published in: American journal of ophthalmology Vol. 229; pp. 184 - 193
• Main Authors: Rasendran, Chandruganesh, Imran, Yahya, Talcott, Katherine E.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2021; Elsevier Limited
• Subjects: Adult; Age; Aged; Codes; Comorbidity; Cross-Sectional Studies; Depression - epidemiology; Educational attainment; Emergency medical care; Ethnicity; Female; Financial Stress; Glaucoma; Health care access; Health care expenditures; Health care policy; Health Expenditures; Health services utilization; Humans; Insurance coverage; Low income groups; Male; Medicare; Mental depression; Older people; Patients; Population; Retrospective Studies; Sociodemographics; United States - epidemiology; United States; United States > US
• ISSN: 0002-9394; 1879-1891; 1879-1891
• DOI: 10.1016/j.ajo.2021.03.062

•Ophthalmic patients with depression faced $5894.86 in annual incremental economic expenditures because of depression, resulting in an additional $22.4 billion annually when extrapolating nationally.•Ophthalmic patients with depression also had higher expenditures for all health care service sections except inpatient and emergency room care, when adjusted for sociodemographics and comorbidities.•For ophthalmic patients with depression, depression was responsible for 6.9% of admissions (the second-leading cause).•Patients with dry eye syndrome, blindness, and retinopathy contribute to the high prevalence of depression for ophthalmic patients. We sought to analyze the incremental economic burden of depression on adults with concurrent ophthalmic conditions in the United States. Retrospective cross-sectional study. Using the Medical Expenditure Panel Survey from 2016 to 2018, ophthalmic patients with ≥1 outpatient visit were identified by International Classification of Diseases, 10th revision, Clinical Modification codes and stratified based on the presence of concurrent depression. A multivariate 2-part regression model was used to determine incremental economic burden, health care sector utilization, and expenditures. Of 7279 ophthalmic patients, 1123 (15.43%) were diagnosed with depression (mean expenditures $17,017.25 ± $2019.13) and 6156 patients (84.57%) without depression (mean expenditures $9924.50 ± $692.94). Patients with depression were more likely to be female, white, lower income, use Medicare/Medicaid, and to have comorbidities (P < .001). These patients faced $5894.86 (95% confidence interval $4222.33-$7348.36, P < .001) in incremental economic expenditures because of depression, resulting in an additional $22.4 billion annually when extrapolating nationally. These patients had higher utilization for all health care service sectors (P < .025 for all) and higher expenditures for outpatient (P = .022) and prescription medications (P = .029) when adjusted for sociodemographic variables and comorbidities. Depression was responsible for 6.9% of inpatient admissions (the second-leading cause) for this cohort of patients. Ophthalmic patients with depression had a higher incremental economic burden and health care service sector utilization and expenditures. Patients with ophthalmic pathologies, including dry eye syndrome, blindness, and retinopathies, were more likely to be depressed. As psychiatric and ophthalmic conditions may have a bidirectional relationship, exacerbating disease severity and financial burden for patients with both, ophthalmologists may need to be more cognizant of the burden of depression among patients.