OBJECTIVES: Previous evidence showed that people with diabetes are at twice greater risk of having depression, and global studies reported that diabetic people with depression consumed more health care services than those without depression. However, this has not been fully explored in Chinese population. The current study aims to compare the health care utilization and expenditures between diabetic patients with and without depression in a metropolitan city in China.

METHODS: A city-level claims database (2012-2015) was used to identify diabetic patients (≥1 claim with a diagnosis of diabetes). Depression was defined by clinical diagnosis as well. Health care utilization included number of outpatient visits, and health expenditures were total medical costs and outpatient-related medical costs. Medical costs were inflated to 2015 RMB and converted to US dollars (USD) using 2015 exchange rate.

RESULTS: A total of 41,693 diabetic patients were identified during 2012-2015, of whom 2,025 (5%) had depression. The mean age of diabetic patients with/without depression were similar (62 vs. 60). However, the average number of outpatient visits per person per year (PPPY) , the average total medical cost PPPY and outpatient-related medical costs PPPY were all significantly higher in diabetic patients with depression than those without depression (the average number of outpatient visits PPPY: 54 vs. 37, p<0.001, the average total medical costs PPPY: USD 2,922 vs. USD 2,121, p<0.001, and the average outpatient-related medical costs PPPY: USD 1,718 vs. USD 1,166, p<0.001, respectively).

CONCLUSIONS: Our study suggests that having depression significantly increases the healthcare burden in diabetic patients in China. Improve management of diabetes and put more efforts to raise the awareness of depression and to prevent its occurrence may potentially reduce the burden.