Resource Use and Expenditures Among Adult Sickle Cell Patients with and without Depression

Depression is commonly associated with less favorable medical outcomes among patients with sickle cell disease (SCD), yet little is known about its associated impact on medical resource use and expenditures. In this study, we descriptively compared inpatient stays, number of hospital admissions, emergency department (ED) visits, outpatient visits, and expenditures for SCD patients with and without depression.

150 adult SCD patients were prospectively enrolled in a cross-sectional cohort study in 2009 to evaluate the prevalence of depression and its association with quality of life, disease severity scores measuring end organ damage, and health care utilization. Detailed cost accounting and administrative physician billing records from the Duke University Health System were obtained for all enrolled patients and used to generate estimates of medical care utilization and costs. Indexing on the enrollment date, we included data representing one year prior to and six months following study entry. Based on the Beck Depression Inventory (BDI) scores, we categorized SCD patients into those with depression (BDI score ≥14) and those without depression (BDI score <14). Given the skewed distributions of resource use and expenditures, we used generalized linear regression models (GLM) with negative binomial distributions and log links to compare inpatient stays, number of hospital admissions, ED visits, and outpatient visits and GLMs with gamma distributions and log links to compare costs associated with each resource use category between patients with and without depression.

Data from 142 patients analyzed, 81 females and 61 males with a mean age of 34.2 years. We identified 50 patients with depression and 92 patients without depression. At study entry, females represented 72% of SCD patients with depression and 49% of SCD patients without depression (P< 0.01). Median age was 32.5 years among patients with depression and 29.5 years among those without depression (P= 0.22). Hospital admissions, ED visits, and outpatient visits were generally similar between patients with and without depression one year prior to and six months after study entry. Patients with depression spent more days in the hospital during both time periods. Total inpatient expenditures, including physician fees paid, were higher for patients with depression than those without depression for both time periods (Table).

SCD patients with depression incur higher expenditures and longer stays than SCD patients without depression. Efforts should be made for early diagnosis and active therapeutic intervention for depression among SCD patients, to decrease health care utilization and cost.

No relevant conflicts of interest to declare.