Alzheimer's, Dementia & Mental Health
Ten-Year Study of Medicaid Depression Patients Sees Big Cost Climb, Small Care Gain
Antipsychotic use increased from 25.9%to 41.9%,cost jumped 939%
Dec. 5, 2011 – The cost of treating Medicaid patients with depression increased substantially over a 10-year period, but
it resulted in just a minimal improvement in the quality of their care, according to a report in the December issue of
Archives of General Psychiatry, one of the
"During the 1980s and 1990s, the number of adults diagnosed with and treated for depression increased, and the modality
of treatment shifted," the authors explain as background information in the article.
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Alzheimer's, Dementia & Mental Health
"The percentage of adults with depression who received antidepressants increased, and the percentage who 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 colleagues
examined data from Medicaid claims in Florida to evaluate changes in depression health service utilization, spending, and quality of care from
July 1996 through June 2006.
Using Medicaid claims data, the authors identified annual cohorts of adults with depression consisting of enrollees age
18 to 64 years having one or more hospitalizations with a principal diagnosis of depression or having at least two outpatient claims of
depression on different days.
The number of enrollees identified annually varied from 8,970 to 13,265 with more persons identified toward the end of
the study period. Total number of individuals with depression identified over the study period was 56,805.
The authors found that during the study period, mental health care spending increased from a mean (average) $2,802 per
enrollee to $3,610 per enrollee, reflecting a 29 percent increase.
This increase appears to result from a large increase in pharmacotherapy spending (110 percent increase), majority of
which was due to spending on antipsychotics (949 percent increase).
During the study period, the percentage of enrollees with depression who received psychotherapy decreased from 56.6
percent to 37.5 percent and the percentage of individuals who were hospitalized decreased from 9.1 percent to 5.1 percent.
Conversely, the percentage of individuals who filled prescriptions within any mental health medication classes remained
stable or increased, depending on the type of prescription filled.
Antidepressant use increased from 80.6 percent to 86.8 percent, anxiety medication use was unchanged at 62.7 percent and
64.4 percent, and antipsychotic use increased from 25.9 percent to 41.9 percent, during the study period.
However, the authors also found that changes in quality of care were mixed, with antidepressant use improving slightly,
psychotherapy utilization fluctuating, and follow-up visits decreasing.
"In summary, during the 10-year period between 1996 and 2005, we found a substantial increase in spending for patients
with depression, with minimal improvements in quality of care," the authors conclude.
"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."
This study was supported by grants from the National Institute of Mental Health.