IMPACT OF COMORBID DEPRESSION ON HEALTH OUTCOMES AMONG ADULTS WITH SICKLE CELL DISEASE IN TEXAS MEDICAID
Author(s)
Pin Hsuan Liao, M.S1, Hyeun Ah KANG, MEd, MS, RPh, PhD1, Jamie Barner, PhD1, Desiree Azizoddin, Psy.D2;
1University of Texas at Austin, Health Outcomes Division, College of Pharmacy, Austin, TX, USA, 2Dana Farber Cancer Institute, Department of Supportive Oncology, Boston, MA, USA
1University of Texas at Austin, Health Outcomes Division, College of Pharmacy, Austin, TX, USA, 2Dana Farber Cancer Institute, Department of Supportive Oncology, Boston, MA, USA
OBJECTIVES: Comorbid depression is prevalent among adults with sickle cell disease (SCD), but its impact on healthcare utilization and costs remains unclear. This study examined associations between comorbid depression and health outcomes among adults with SCD.
METHODS: This retrospective cohort study analyzed 2016-2023 Texas Medicaid claims. Adults (18-63 years) with ≥1 inpatient or ≥2 outpatient SCD claims, no cancer, continuous enrollment (6 months pre- and 12 months post-index), and ≥1 SCD claim during 12-month follow-up were included. Index dates were the first depression diagnosis (depression group) or first SCD claim (non-depression group) from July 01, 2016 to July 31, 2022. Outcomes included SCD-related emergency department (ED) visits, vaso-occlusive crises (VOCs), and SCD-related costs. Covariates included age, sex, baseline Charlson Comorbidity Index (CCI), and numbers of baseline ED visits, VOCs, and outpatient visits. Negative binomial and generalized linear models with gamma distribution were used.
RESULTS: Among 676 patients (mean age 33.0±11.0 years; 67.9% female), 340 (50.3%) had comorbid depression. Depression was not significantly associated with ED visits nor VOCs, but predicted 94% higher SCD-related costs (RR=1.94, 95% CI: 1.57-2.40, p<0.001). Regarding covariates, compared to ages 18-21, those aged 27-34 had 44% more VOCs (IRR=1.44, p=0.036) and 30% lower costs (RR=0.70, p=0.03); ages 45-64 had 46% more VOCs (IRR=1.46, p=0.05). Females had 35% fewer ED visits (IRR=0.65, p=0.0007), 30% fewer VOCs (IRR=0.70, p=0.002), and 38% lower costs (RR=0.62, p<0.0001). Baseline VOC events predicted higher ED visits (IRR=1.31, p<0.0001), VOCs (IRR=1.34, p<0.0001), and costs (RR=1.16, p<0.0001). Higher baseline comorbidity burden (CCI>2) predicted 51% higher costs (RR=1.51, p=0.018).
CONCLUSIONS: Among adult patients with SCD, comorbid depression was not associated with increased ED visits nor VOC events, but predicted higher healthcare costs. These findings highlight the economic burden of comorbid depression among these patients and underscore the critical need for integrated mental health services in SCD care management.
METHODS: This retrospective cohort study analyzed 2016-2023 Texas Medicaid claims. Adults (18-63 years) with ≥1 inpatient or ≥2 outpatient SCD claims, no cancer, continuous enrollment (6 months pre- and 12 months post-index), and ≥1 SCD claim during 12-month follow-up were included. Index dates were the first depression diagnosis (depression group) or first SCD claim (non-depression group) from July 01, 2016 to July 31, 2022. Outcomes included SCD-related emergency department (ED) visits, vaso-occlusive crises (VOCs), and SCD-related costs. Covariates included age, sex, baseline Charlson Comorbidity Index (CCI), and numbers of baseline ED visits, VOCs, and outpatient visits. Negative binomial and generalized linear models with gamma distribution were used.
RESULTS: Among 676 patients (mean age 33.0±11.0 years; 67.9% female), 340 (50.3%) had comorbid depression. Depression was not significantly associated with ED visits nor VOCs, but predicted 94% higher SCD-related costs (RR=1.94, 95% CI: 1.57-2.40, p<0.001). Regarding covariates, compared to ages 18-21, those aged 27-34 had 44% more VOCs (IRR=1.44, p=0.036) and 30% lower costs (RR=0.70, p=0.03); ages 45-64 had 46% more VOCs (IRR=1.46, p=0.05). Females had 35% fewer ED visits (IRR=0.65, p=0.0007), 30% fewer VOCs (IRR=0.70, p=0.002), and 38% lower costs (RR=0.62, p<0.0001). Baseline VOC events predicted higher ED visits (IRR=1.31, p<0.0001), VOCs (IRR=1.34, p<0.0001), and costs (RR=1.16, p<0.0001). Higher baseline comorbidity burden (CCI>2) predicted 51% higher costs (RR=1.51, p=0.018).
CONCLUSIONS: Among adult patients with SCD, comorbid depression was not associated with increased ED visits nor VOC events, but predicted higher healthcare costs. These findings highlight the economic burden of comorbid depression among these patients and underscore the critical need for integrated mental health services in SCD care management.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
CO151
Topic
Clinical Outcomes
Topic Subcategory
Clinical Outcomes Assessment
Disease
SDC: Rare & Orphan Diseases, SDC: Systemic Disorders/Conditions (Anesthesia, Auto-Immune Disorders (n.e.c.), Hematological Disorders (non-oncologic), Pain)