Association between depression symptom severity and total cost of care: Findings from a large, 2-year, claims-based, retrospective population health study.

Background: Despite the substantial impact of depression on individuals and healthcare utilization, little is known about the specific relationship between depression severity and total cost of care (TCC). This study evaluates the association between depression symptom severity and TCC and how changes in severity affect TCC.

Methods: The analysis was conducted using insurance claims data and data from electronic health records between January 1, 2019 and December 31, 2020. Inclusion criteria comprised insured individuals with coverage during 2019 or 2020, aged one year or older, and identified as having depression in at least one year of the study. Depression symptom severity was assessed using the screening Identification and Stratification (IDS) framework and data available to the research team. The main outcome was TCC per member per month (PMPM) evaluated across the two-year period.

Results: Across 2019 and 2020, 744,854 members met inclusion criteria. A total of 369,460 members were studied across both years. Greater depression symptom severity was associated with higher TCC across both years. Unchanged severity was associated with limited change in TCC from 2019 to 2020. Decrease in depression symptoms was associated with an average $41 reduction in PMPM spend, whereas increase in depression symptom severity was associated with an average $608 increase.

Limitations: Limitations include fragmented data, retrospective design that limits causality, and the IDS framework design.

Conclusion: Changes in depression symptom severity were significantly associated with changes in TCC. Findings reveal financial and clinical opportunities associated with early identification and targeted management of depression.