Treatment patterns and resource use among patients with comorbid diabetes mellitus and major depressive disorder

Figures & data

Figure 1.  Inclusion – exclusion criteria and sample size.

Table 1.  Patient characteristics.

Characteristics	Diabetes with comorbid depression n = 5826		Diabetes without comorbid depression n = 398,522		p-value
	n	%	n	%
Gender					<0.0001
Male	2,113	36.3	213,953	53.7
Female	3,713	63.7	184,569	46.3
Age at index date					<0.0001
Mean & SD	57.7	11.2	62.2	12.7
Median & range	57	18–96	61	18–106
Age group at index date					<0.0001
18–24 years	21	0.4	1,651	0.4
25–34 years	78	1.3	5,657	1.4
35–44 years	440	7.6	23,335	5.9
45–54 years	1,763	30.3	75,784	19.0
65+ years	2,058	35.3	115,642	29.0
Plan type					<0.0001
Missing/unknown	26	0.4	2,756	0.7
Comprehensive	2,172	37.3	163,363	41.0
Exclusive provider org	13	0.2	707	0.2
Health maintenance org	904	15.5	60,216	15.1
POS w/out capitation	497	8.5	33,898	8.5
PPO	2,142	36.8	133,404	33.5
POS w/ capitation	63	1.1	3,610	0.9
CDHP	9	0.2	568	0.1

Table 2.  Comorbidities.

Comorbidity	Diabetes with depression		Diabetes without depression		p-value
	n	%	n	%
Certain conditions originating in the perinatal period	23	0.4	636	0.2	<0.0001
Complications of pregnancy, childbirth, and the puerperium	20	0.3	1,074	0.3	<0.0001
Congenital anomalies	313	5.4	15,074	3.8	<0.0001
Diseases of the blood and blood-forming organs	1,158	19.9	58,215	14.6	<0.0001
Diseases of the circulatory system	4,429	76.0	292,848	73.5	<0.0001
Diseases of the digestive system	2,728	46.8	130,598	32.8	<0.0001
Diseases of the genitourinary system	3,219	55.3	167,173	41.9	<0.0001
Diseases of the musculoskeletal system and connective tissue	4,472	76.8	244,077	61.2	<0.0001
Diseases of the nervous system and sense organs	3,933	67.5	231,519	58.1	<0.0001
Diseases of the respiratory system	3,702	63.5	195,349	49.0	<0.0001
Diseases of the skin and subcutaneous tissue	2,768	47.5	152,443	38.3	<0.0001
Endocrine, nutritional and metabolic diseases, and immunity disorders	3,560	61.1	202,866	50.9	<0.0001
Infectious and parasitic diseases	1,689	29.0	80,788	20.3	<0.0001
Injury and poisoning	3,075	52.8	143,831	36.1	<0.0001
Mental disorders	2,397	41.1	36,207	9.1	<0.0001
Neoplasms	2,036	34.9	126,399	31.7	<0.0001
Other/unknown/missing	5,772	99.1	393,603	98.8	<0.0001
Symptoms, signs, and ill-defined conditions	5,061	86.9	291,820	73.2	<0.0001
Charlson Comorbidity Index					<0.0001
Mean (SD)	2.6	1.98	2.3	1.91

Table 3.  Annualized drug class utilization.

Medication	Diabetes with depression		Diabetes without depression		p-value
	n	%	n	%
Number of patients with at least one pharmacotherapy prescription	5,680	97.5	337,486	84.7	<0.0001
Antidepressant use					<0.0001
SSRI antidepressants	3,731	64.0	62,830	15.8	<0.0001
SSNRI antidepressants	2,035	34.9	17,307	4.3	<0.0001
Miscellaneous antidepressants	1,685	28.9	12,381	3.1	<0.0001
Phenylpiperazine antidepressants	1,118	19.2	8,767	2.2	<0.0001
Tricyclic antidepressants	959	16.5	22,550	5.7	<0.0001
Tetracyclic antidepressants	604	10.4	3,385	0.8	<0.0001
Psychotherapeutic combinations	39	0.7	493	0.1	<0.0001
Monoamine oxidase inhibitors	20	0.3	21	0.0	<0.0001
Total	5,419	93.0	101,485	25.5	<0.0001
Insulin use	1,966	33.7	106,857	26.8	<0.0001
Non-insulin use
Thiazolidinediones	2,191	37.6	153,919	38.6	0.1141
Sulfonylureas	2,180	37.4	169,648	42.6	<0.0001
Antidiabetic combinations	711	12.2	60,362	15.1	<0.0001
Miscellaneous antidiabetic agents	474	8.1	21,221	5.3	<0.0001
Meglitinides	273	4.7	17,149	4.3	0.1532
Alpha-glucosidase inhibitors	63	1.1	3,985	1.0	0.5355
Total	3,710	63.7	274,084	68.8	<0.0001

Table 4a.  Resource utilization – frequency of use.

	Diabetes with depression		Diabetes without depression		p-value
	n	%	n	%
Diabetes-related visits*
Inpatient	148	2.5	6,023	1.5	<0.0001
Outpatient	5,618	96.4	375,090	94.1	<0.0001
ER	326	5.6	13,931	3.5	<0.0001
Total	5,622	96.5	375,476	94.2	<0.0001
Depression-related visits*
Inpatient	268	4.6	–	–	NA
Outpatient	5,779	99.2	–	–	NA
ER	93	1.6	–	–	NA
Total	5,800	99.6	–	–	NA
Other visits*
Inpatient	2,164	37.1	106,346	26.7	<0.0001
Outpatient	5,799	99.5	392,535	98.5	<0.0001
ER	3,301	56.7	158,739	39.8	<0.0001
Total	5,826	100.0	398,368	100.0	NA
Total visits*
Inpatient	2,333	40.0	109,183	27.4	<0.0001
Outpatient	5,826	100.0	395,237	99.2	NA
ER	3,340	57.3	161,731	40.6	<0.0001
Total	5,826	100.0	398,522	100.0	NA

*Percentage represents the percentage of individuals with at least one visit.

Table 4b.   Resource utilization - mean use.

	Diabetes with depression			Diabetes without depression			p-value
	Mean	SD	Median	Mean	SD	Median
Diabetes-related visits
Inpatient	0.8	1	0.5	0.6	0.3	0.5	0.0003
Outpatient	4.7	4.4	3.5	3.9	3.5	3	<0.0001
ER	0.8	0.8	0.5	0.8	0.8	0.5	0.6654
Total	4.7	4.5	3.5	3.9	3.5	3	<0.0001
Depression-related visits
Inpatient	0.7	0.4	0.5	–	–	–	NA
Outpatient	7	8.9	4	–	–	–	NA
ER	1.2	2.9	0.5	–	–	–	NA
Total	7.1	8.9	4	–	–	–	NA
Other visits
Inpatient	1	0.9	0.5	0.8	0.5	0.5	<0.0001
Outpatient	26.2	23.3	20	16.3	16.6	11.5	<0.0001
ER	2.3	3.7	1.5	1.5	1.7	1	<0.0001
Total	27.8	25.2	21	16.9	17.4	12	<0.0001
Total visits
Inpatient	1	1	0.5	0.8	0.6	0.5	<0.0001
Outpatient	37.6	26.7	31.5	19.9	17.7	15	<0.0001
ER	2.4	3.8	1.5	1.6	1.8	1	<0.0001
Total	39.4	28.5	32.5	20.6	18.6	15.5	<0.0001

Table 5.  Annualized healthcare costs – among users of service.

	Diabetes with depression			Diabetes without depression			p-value
	Mean	SD	Median	Mean	SD	Median
Diabetes-related costs
Inpatient	7,503.9	15,201.1	3,159.5	6,448.9	11,455.4	2,875.4	0.3800
Outpatient	569.2	1,080.2	309.5	434.2	872.2	247.0	<0.0001
ER	259.6	672.3	105.6	210.2	461.2	86.5	0.0213
Total	781.4	3,281.1	316.2	545.0	1,984.4	251.3	<0.0001
Depression-related costs
Inpatient	4,708.0	5,216.8	2,899.1	–	–	–	NA
Outpatient	629.1	1,224.2	283.0	–	–	–	NA
ER	253.5	458.5	105.0	–	–	–	NA
TOTAL	848.4	2,076.2	296.2	–	–	–	NA
Other costs
Inpatient	11,275.1	18,331.7	5,225.0	9,433.0	17,818.5	4,444.3	<0.0001
Outpatient	6,684.8	13,884.6	3,734.1	4,364.1	10,388.9	2,101.7	<0.0001
ER	691.6	1,628.4	281.8	442.7	1,124.3	197.7	<0.0001
Total	18,108.3	23,495.9	11,954.7	10,727.7	17,440.5	6,339.1	<0.0001
Pharmacy costs
Anti-depressant	1,078.2	940.7	841.2	410.4	473.0	264.6	<0.0001
Non-anti-depressant	5,927.7	5,577.8	4,721.2	3,674.1	3,435.0	3,024.0	<0.0001
Total	6,940.2	5,856.5	5,725.8	3,779.8	3,507.3	3,107.9	<0.0001
Total costs
Inpatient	11,475.2	18,753.1	5,353.0	9,543.7	18,105.3	4,452.4	<0.0001
Outpatient	7,826.6	14,101.6	4,926.0	4,746.4	10,490.1	2,466.1	<0.0001
ER	715.9	1,724.3	290.1	452.6	1,130.7	203.0	<0.0001
Pharmacy	6,940.2	5,856.5	5,725.8	3,779.8	3,507.3	3,107.9	<0.0001
Total	19,706.9	24,401.6	13,219.7	11,237.1	17,873.7	6763.8	<0.0001