A longitudinal study of healthcare utilisation and expenditure in people with type 2 diabetes mellitus with and without major depressive disorder

Abstract

Objective: This study investigated the healthcare service utilisation and expenditure of patients with type 2 diabetes mellitus (T2DM) and major depressive disorder (MDD) and identified associated factors.

Methods: Healthcare service utilisation and expenditure of patients with T2DM with and without MDD during 2002-2013 were examined using Taiwan's population-based National Health Insurance claims database. Healthcare service utilisation included outpatient visits and inpatient admissions, and health expenditure included outpatient, inpatient, and total medical expenditure. Moreover, non-psychiatric health service utilisation and expenditure were distinguished from total health service utilisation and medical expenditure.

Results: Average healthcare service utilisation was significantly higher in those with comorbid MDD (both total and non-psychiatric utilisation). The higher overall costs of the patients with comorbid MDD largely driven by psychiatric costs and non-psychiatric costs between the groups were not significantly different. Gender, age, income, comorbidities and complications, and diabetes complications severity index were significant factors in outpatient visits, medical expenditure, and hospitalisation in those with comorbid MDD.

Conclusions: Type 2 diabetes patients with comorbid MDD were found to have higher costs, and that they appeared to be driven by more visits in the first 6 years and by psychiatric-related costs rather than general medical costs.

Keywords: Expenditure; Healthcare utilisation; Major depressive disorder; Type 2 diabetes mellitus.