Mueller M (Charleston VA TREP), Egede LE
(Charleston VA TREP), Zhao Y
(Charleston VA TREP), Mauldin PD
(Charleston VA TREP), Chen GJ
(Charleston VA TREP), Durkalski VL
(Charleston VA TREP), Moran PW
(Charleston VA TREP)
Prior studies have shown that depression is associated with increased health care cost in persons with diabetes. However, the effect of depression on VA cost has not been studied. This study assessed the effect of depression on VA costs for veterans with type 2 diabetes.
In this retrospective study, fiscal year 2004 data were analyzed on 6,137 veterans from the Ralph H. Johnson VA Medical Center in Charleston SC with type 2 diabetes. Veterans were identified through administrative data using established algorithms. Patient-specific cost data was retrieved from DSS. Diagnosis of depression was based on ICD-9 codes using established algorithms. A generalized linear model was used to examine the effect of depression on logged-transformed costs controlling for age, gender, race, marital status, employment status and comorbidity (stroke, cancer, heart disease, hypertension, congestive heart failure, and mental illness other than depression). All statistical tests used a 2-tailed a=0.05 level of significance and were performed using SAS statistical software.
Out of the 6,137 type 2 diabetic veterans in our sample, 396 (6.5%) were depressed. Mean age for the sample was 62 years. 97% were men, 47% were NH Whites, 28% were NH Blacks, 24% were of unknown race/ethnicity, and 1% was Hispanic. 67% were married and 45% were unemployed. 27% had hypertension, 14% had heart disease, 13% had mental illness other than depression, 7% had congestive heart failure, and 4% had cancer. Mean total costs were $19,948 for depressed diabetic veterans and $6,267 for non-depressed diabetic veterans (p < 0.0001). The multivariate analysis on logged-transformed total costs revealed that depressed diabetic veterans had significantly higher VA costs than non-depressed diabetic veterans (P < 0.0001).
Type 2 diabetic veterans with comorbid depression are significantly more costly to the VA compared to diabetic veterans without comorbid depression.
The findings of this study suggest that significant cost saving to VHA can be achieved by developing effective interventions to improve recognition and treatment of comorbid depression in veterans with type 2 diabetes.