OBJECTIVES

Depression and anxiety are highly prevalent in adults NCPC and pose a substantial economic burden. The association of coexisting depression and anxiety to economic burden in the United States is unknown. We estimated excess healthcare expenditures of co-existing depression and anxiety among adults (age >18 years) with NCPC.

METHODS

We used a cross-sectional design with data from the Medical Expenditure Panel Survey. We included adults with NCPC (arthritis, gout, headache, back and neck pain, and musculoskeletal disorders), without cancer, and whom reported pain interference during normal activities (n=5,246).Economic burden was assessed with total, third-party healthcare expenditures, and patients’ high out-of-pocket burden (spending >10% income on healthcare). Adjusted generalized linear models (GLM) with gamma distribution and log link were used to analyze total and third-party expenditures; multivariable logistic regression on out-of-pocket-burden was used to assess the excess economic burden associated with co-existing depression and anxiety.

RESULTS

Overall, 9.5% (Weighted N = 5,618,770) had coexisting depression and anxiety. Unadjusted average total healthcare expenditures were higher (total: $16,114 vs. $8,357; third-party: $14,660 vs. $7,366) among NCPC adults with depression+anxiety compared to those without depression and without anxiety, translating into $90.5 billion in total expenditures for the former. Adjusted total ($9,229 vs. $5,406) and third-party healthcare expenditures ($6,899 vs. $4,155) were also higher among those with depression+anxiety compared to those without depression and without anxiety. Further, those with depression+anxiety were more likely to incur higher out-of-pocket burden (AOR = 2.45; 95%CI = 1.86, 3.22).

CONCLUSIONS

One in 10 adults with NCPC had coexisting depression and anxiety and it was associated with high economic burden for the payers as well as patients. Future studies need to explore whether innovative payment models that de-emphasize “disease-oriented” care can reduce the high economic burden in NCPC adults with depression and anxiety.