WASHINGTON – Treating depression in cancer patients has the potential to simultaneously improve the patients’ mental health while reducing health care costs, investigators say.
Patients with cancer and depression have significantly more emergency and nonemergency visits and are more likely to be hospitalized as well as rehospitalized within 30 days than nondepressed cancer patients, suggesting that active treatment of depression in cancer patients can pay off in both better patient care and lower costs, reported Dr. Brent Mausbach, a clinical psychologist at the University of California, San Diego Moores Cancer Center.
Dr. Brent T. Mausbach
“If we’re looking at 1,000 depressed cancer patients and we compare them to 1,000 nondepressed cancer patients, what this essentially equates to is over $4 million in extra cost – and this only includes the cost of the emergency department and hospitalizations; it does not include the cost of other visits that these patients may be making,” he said at the joint congress of the International Psycho-Oncology Society and the American Psychosocial Oncology Society.
Dr. Mausbach and colleagues took a retrospective look at the charts of 5,055 patients with cancer treated at their center in 2011, including 561 with a diagnosis of depression and 4,494 with no depression.
The investigators counted the total number of visits, emergency department (ED) visits, and 30-day readmissions, and calculated the probability that a randomly selected depressed patient would have more visits than a randomly selected nondepressed patient.
They controlled for patient demographics (age, sex, and race/ethnicity), insurance status, months since cancer diagnosis, comorbidities, and metastasis.
They found that patients who were depressed had a mean of 26.9 visits over 12 months vs. 15 for nondepressed patients. Compared with nondepressed patients, depressed patients had a 72.5% probability of having more health care visits.
The median number of visits to the health care system among depressed cancer patients was 21, compared with 8 for nondepressed patients.
In all, 28.3% of depressed patients had one or more emergency department visits for any reason, compared with 11.5% of nondepressed patients (odds ratio, 3.05; adjusted OR, 2.45).
Similarly, depressed patients were significantly more likely to be hospitalized than their nondepressed counterparts (OR, 2.41; aOR, 1.81), and to be rehospitalized within 30 days (OR, 2.31; aOR, 2.03).
Patients with depression also had significantly longer hospital stays, at a mean of 6.1 vs. 4.7 for those without depression.
“For the emergency department, hospitalization, and 30-day rehospitalization data, we think the effects seemed pretty consistent across all those outcomes. Essentially there was about a doubling of the risk for patients who have depression for all of those outcomes relative to patients without depression,” Dr. Mausbach said.
He noted that there is an “overwhelming temptation” for investigators to assume the between-person effects they saw could translate directly into within-person effects. For example, an observer might extrapolate from the data that treating depression in an individual patients could halve that patient’s use of health care resources, but a longitudinal study would be required to correctly address that question, he said.
Additionally, the study was limited by a lack of data on cancer stage and grade, and by the uncertainties surrounding a chart-recorded diagnosis of depression.
“Can we treat depression and then have an impact on lower health care use and overall costs? We need to demonstrate this using clinical trials or pseudo-experimental designs, which would include taking a look at people who actually received psychotherapy or medications, and checking to see whether by using these treatments they actually had a reduction in total number of health care visits,” Dr. Mausbach said.
The study was institutionally supported. The authors reported having no conflicts of interest.