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Depression treatment costs go up while quality of care declines

Although the use of psychotherapy and hospitalizations to treat depression has declined in recent years, the overall cost of depression treatment has increased significantly in the U.S. The reason for this, according to Medicaid claims data, is the increasing use of psychiatric and antipsychotic drugs to treat depression.

Specifically, depression treatment costs rose by about one-third between 1996 and 2006, with average per-patient mental health spending increasing from $2802 to $3610 over that decade, and likely continuing that upward trend in the years since. At the same time, the quality of care received by patients has declined. The National Institute of Mental Health estimates that about 15 million adults in California and across the United States suffer from major depression.

Quality of care for patients of depression is measured by the amount of treatment received by patients, whether in the form of in-person treatment by a doctor or sustained use of prescription medications. Because the use of antidepressants and antipsychotics has increased (with fewer follow-up visits) while talk therapy and hospitalizations have declined, patients are getting less face time with their doctor, and thus a lower quality of care.

If medication was proven to work better than traditional psychotherapy, the resulting increase in cost would likely not be an issue. However, there is no proof that antidepressants and antipsychotics are any more effective than talk therapy, so their increased use may not be worth the cost, says health economics professor Thomas McGuire. "Antipsychotics are powerful drugs with significant side effects," he said. "It is not clear that the additional risks and costs are justified."

Source: Reuters, "Spending on depression up, quality of care lagging," Frederik Joelving, Dec. 6, 2011

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