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Excess Medical Expenditure Associated with Postpartum Depression among Privately Insured Women
Excess Medical Expenditure Associated with Postpartum Depression among Privately Insured Women
Tuesday, June 25, 2019
Exhibit Hall C (Marriott Wardman Park Hotel)
Background: Postpartum depression is a common condition that may affect the health of both mothers and infants. However, little is known about health care utilization and medical cost associated with postpartum depression. Information on excess medical expenditure on postpartum depression is important to understand the magnitude of financial burden associated with the condition and to inform efficient allocation of resources to manage it.
Research Questions: What was the prevalence of diagnosed postpartum depression among privately insured women? What were the excess health care utilization and direct medical costs associated with postpartum depression?
Methods: We used the 2009-2014 IBM® MarketScan® Commercial Claims and Encounters databases for the analysis. Our study population consisted of 263,858 women aged 15-45 years with a live birth between January 2009 through December 2014, who were continuously enrolled in a fee-for-service health plan from 12 months before pregnancy through 12 months after the delivery, and with prescription drug coverage. Postpartum depression was identified as having any inpatient admission with a depression diagnosis or having at least two outpatient health care encounters with a depression diagnosis at least 30 days apart, within one year after delivery (days 0-365). A depression diagnosis was identified as having the following ICD-9-CM codes in any diagnosis field: major depressive disorder (296.2x, 296.3x), dysthymia (300.4), premenstrual dysphoric disorder (625.4), substance-mediation induced depressive disorder (291.89, 292.84), depressive disorder due to another medical condition (293.83), or depressive disorder otherwise not specified (NOS) (311).
Excess health care utilization and medical costs associated with postpartum depression was measured as the adjusted mean difference in the number of inpatient admissions, inpatient length of stay (LOS), number of outpatient visits, and total costs (including outpatient, inpatient, and prescription drug costs) during the one year after delivery between women with a postpartum depression diagnosis and those without. Negative binomial models and generalized linear models with a log link and gamma distribution were used to estimate the excess health services use and medical expenditures associated with postpartum depression, respectively, controlling for age, residency, region, and medical comorbidities (chronic diabetes and gestational diabetes). All expenditures were adjusted to 2014 U.S. dollars.
Results: In total, 4.0% of women had a postpartum depression diagnosis. Women with depression are more likely to have coexisting chronic diabetes (odds ratio: 1.43, p<0.001) and gestational diabetes (odds ratio: 1.06, p=0.006). Regression analysis results showed that on average, women with postpartum depression had 0.1 more inpatient visits (predicted mean: 1.2), 0.9 more days inpatient LOS (predicted mean: 3.8), and 6.0 more outpatient visits (predicted mean: 14.5), compared to women without postpartum depression (predicted means: 1.1 inpatient visits, 2.9 days inpatient LOS, 8.5 outpatient visits). Women with postpartum depression incurred $5,430 (34% relative increase) higher total medical expenditures (predicted mean: $21,180) compared to women without postpartum depression (predicted mean: $15,750). All p values are < 0.001.
Conclusions and policy implications: Postpartum depression is associated with excess health care utilization and medical expenditures. It is important to identify and implement effective and efficient interventions to manage this condition.
Research Questions: What was the prevalence of diagnosed postpartum depression among privately insured women? What were the excess health care utilization and direct medical costs associated with postpartum depression?
Methods: We used the 2009-2014 IBM® MarketScan® Commercial Claims and Encounters databases for the analysis. Our study population consisted of 263,858 women aged 15-45 years with a live birth between January 2009 through December 2014, who were continuously enrolled in a fee-for-service health plan from 12 months before pregnancy through 12 months after the delivery, and with prescription drug coverage. Postpartum depression was identified as having any inpatient admission with a depression diagnosis or having at least two outpatient health care encounters with a depression diagnosis at least 30 days apart, within one year after delivery (days 0-365). A depression diagnosis was identified as having the following ICD-9-CM codes in any diagnosis field: major depressive disorder (296.2x, 296.3x), dysthymia (300.4), premenstrual dysphoric disorder (625.4), substance-mediation induced depressive disorder (291.89, 292.84), depressive disorder due to another medical condition (293.83), or depressive disorder otherwise not specified (NOS) (311).
Excess health care utilization and medical costs associated with postpartum depression was measured as the adjusted mean difference in the number of inpatient admissions, inpatient length of stay (LOS), number of outpatient visits, and total costs (including outpatient, inpatient, and prescription drug costs) during the one year after delivery between women with a postpartum depression diagnosis and those without. Negative binomial models and generalized linear models with a log link and gamma distribution were used to estimate the excess health services use and medical expenditures associated with postpartum depression, respectively, controlling for age, residency, region, and medical comorbidities (chronic diabetes and gestational diabetes). All expenditures were adjusted to 2014 U.S. dollars.
Results: In total, 4.0% of women had a postpartum depression diagnosis. Women with depression are more likely to have coexisting chronic diabetes (odds ratio: 1.43, p<0.001) and gestational diabetes (odds ratio: 1.06, p=0.006). Regression analysis results showed that on average, women with postpartum depression had 0.1 more inpatient visits (predicted mean: 1.2), 0.9 more days inpatient LOS (predicted mean: 3.8), and 6.0 more outpatient visits (predicted mean: 14.5), compared to women without postpartum depression (predicted means: 1.1 inpatient visits, 2.9 days inpatient LOS, 8.5 outpatient visits). Women with postpartum depression incurred $5,430 (34% relative increase) higher total medical expenditures (predicted mean: $21,180) compared to women without postpartum depression (predicted mean: $15,750). All p values are < 0.001.
Conclusions and policy implications: Postpartum depression is associated with excess health care utilization and medical expenditures. It is important to identify and implement effective and efficient interventions to manage this condition.
