Abstract PD4-4: Prevalence, health care utilization and costs of concomitant depression among breast cancer survivors
Authors: Jeffery Diana D 
Published: May 2015

Abstract
Purpose: Concomitant conditions in a cohort of non-elderly breast cancer survivors (BCS) were examined with a focus on the prevalence, healthcare utilization, and costs of diagnosed depression. Little research has been conducted on how concomitant depression among cancer survivors impacts utilization and costs of care.
Methods. Using administrative claims data from the Military Health System Data Repository (MHSDR), a cohort of 2,851 BCS was identified with at least 2 years survival from the time of diagnosis. Concomitant conditions were based on ICD-9 codes; codes 296.2, 296.3, 298.0, and 311 were used to identify depression. Fiscal year 2009 was used as the index year to calculate healthcare utilization and costs. Bivariate analyses and logistic regression analysis were used to examine group differences and predictors of having received a diagnosis of depression.
Findings. The most common concomitant chronic conditions in the BCS cohort were hypertension (50.0%), mood disorders or adjustment disorders (37.5%), heart disease (23.0%), diabetes (19.9%), history of tobacco use (19.7%), asthma or chronic obstructive pulmonary disease (16%), and obesity (16.8%). About 15.9% of the BCS were diagnosed with depression in the year prior to, at the time of, or in the 2-year follow up period after the cancer diagnosis. With bivariate analysis, significant differences were found between BCS with and without depression: those with depression had higher mean number of hospital stays (.33 vs .11), mean number of bed days (1.94 vs .58), mean number of ambulatory visits (34.26 vs 20.42), and mean number of pharmacy prescriptions (45.49 vs 27.60). For follow up care, BCS with a diagnosis of depression cost, on average, $7174 more annually then those without a diagnosis of depression ($15,471 vs $8,297). No demographic characteristics significantly increased the likelihood of having received a diagnosis of depression.
Discussion. The results show much higher annual health care utilization and costs for BCS diagnosed with depression compared to BCS without a diagnosis of depression. These findings may reflect the health care plan provided to military-related beneficiaries, a plan that has few restrictions for cancer follow up care if medically ordered. Claims data contains no information about cancer stage, a correlate of health care utilization and costs. Overall, the findings provide empirical evidence that there is a fiscal incentive to screen and manage mild symptoms prior to patients meeting diagnostic criteria for clinical depression. Assumedly, timely screening and rapid intervention will lead to improved quality of life for the patient, decreased utilization of health care resources, and cost savings for health care plans. In this respect, the findings support the 2014 ASCO recommendations regarding screening and treatment for depression and anxiety. Conversely, the data intimate that adoption of the ASCO recommendations will lead to higher costs as more individuals are positively screened and referred for treatment. Who, what, or how such services will be afforded merits sustained inquiry.
The opinions expressed herein are those of the author and are not necessarily representative of the opinions or policies of the Department of Defense.
Citation Format: Diana D Jeffery. Prevalence, health care utilization and costs of concomitant depression among breast cancer survivors [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr PD4-4.