Ten-Year Trends in Quality of Care and Spending for Depression

Abstract

Context Over the past decade, the introduction of generic versions of newer antidepressants and the release of FDA-warnings regarding suicidality in children, adolescents, and young adults may have had an impact on cost and quality of depression treatment. Objectives To examine longitudinal trends in service use, spending, and treatment quality for depression. Design Observational, trend study. Setting Florida, Medicaid enrollees from July 1996 to June 2006. Subjects Annual cohorts aged 18-64 diagnosed with depression. Main Outcome Measures Mental-health spending adjusted for inflation and case mix and components of mental-health spending, including inpatient, outpatient, and medication expenditures. Quality measures included measures of medication adherence, psychotherapy, and follow-up visits. Results Mental-health spending increased from an average of $2802 per enrollee to $3610 over this time period (29% increase). This increase occurred despite a mean decrease in inpatient spending (from $641 per enrollee to $373) and was driven primarily by an increase in pharmaceutical spending (up 110%) the bulk of which was due to spending on antipsychotics (up 949%). The percentage of enrollees with depression who were hospitalized decreased from 57% to 37% and the percentage using psychotherapy decreased from 9% to 5%. Antidepressant use increased from 82% to 87%, anxiety medication use was unchanged at 64%, and antipsychotic use increased from 27% to 42%. Changes in treatment quality were mixed, with measures of antidepressant use improving slightly, measures examining follow-up visits decreasing, and measures of psychotherapy utilization fluctuating. Conclusions Over a ten-year period, we found a substantial increase in spending for enrollees with depression associated with minimal improvements in quality of care. Antipsychotic use contributed significantly to the increase in spending while contributing little to traditional measures of quality.

The Effects of the Transition From Medicaid to Medicare on Health Care Use for Adults With Mental Illness

“…(4) Given the low rates of outpatient treatment for psychiatric and medical conditions in this vulnerable and costly population,(7, 8, 10, 11) it is likely that some patients benefitted from the increased use of outpatient care. Additional research is needed to assess the impact of this coverage change on beneficiaries' health, functioning, and satisfaction, as well as the efficiency of the resulting care.…”

“…(3–6) Health care expenditures are 1.8 times higher for non-elderly dual enrollees with a mental health disorder compared to other non-elderly duals. (4) However, use of medical(7) and mental health care(8–11) (12) among publicly insured adults with SMI often falls short of perceived needs and expert recommendations, increasing the risk of adverse and costly health outcomes for beneficiaries and payers. (13–15)…”

Determining adolescents' suitability for inpatient psychotherapy: Utility of the clinician-rated Readiness for Inpatient Psychotherapy Scale with an adolescent inpatient sample

“…Current trends in mental health reveal a decrease in the utilization of inpatient psychotherapy services, despite data suggesting that the combination of psychotherapy with pharmacotherapy is most efficacious (Fullerton et al, 2011). At the present time, the RIPS is the only clinician-rated measure designed to assess readiness for inpatient psychotherapy for adolescents.…”

Childhood Trauma and Major Mental Illness – Integration of Psychopharmacology with Psychological Treatments

“…There has been an increasing reliance on psychotropic medication, particularly antipsychotics while corresponding benefits in patients' quality of care remain limited. In a 10 year study [7] it was found that while the percentage of patients hospitalized for depression dropped from 9.1% to 5.1%, the percentage of individuals receiving psychotherapy decreased from 56.6% to 37.5%, the use of antidepressants increased from 80.6% to 86.8 % and the use of antipsychotics increased significantly from 25.9% to 41.9%. Additionally, the percentage of acute-phase episodes in which patients received psychotherapy dropped from 42.6% to 26.9% and the prescription for antipsychotics remained relatively constant.…”