OBJECTIVES: Newly diagnosed patients with breast cancer often experience psychological distress. We evaluated the incidence and prevalence of psychiatric disorders including anxiety, depression, stress reaction and adjustment disorders and their associations with healthcare costs among newly diagnosed patients with breast cancer.

METHODS: This retrospective observational cohort study was conducted using Aetna claims databases. Patients with breast cancer (ICD-10-CM: C50.x) were identified during the study period (01/01/2017 – 12/31/2020). The index date was defined as the first diagnosis date of breast cancer. Patients had to be ≥18 years of age and be enrolled in the health plan for ≥12 months before and after the index date, respectively. Demographics and comorbidities were assessed using data within 12 months prior to the index date. Psychiatric disorders and costs were examined using data within 12 months after the index date. Generalized linear regressions were performed to examine the associations between psychiatric disorders and healthcare costs.

RESULTS: Of the 6,392 patients with newly diagnosed breast cancer, 38.2% diagnosed with psychiatric disorders including anxiety (27.7%), depression (21.9%), and stress reaction and adjustment disorders (6%). Overall, 23.2% had psychiatric disorders at baseline, 15% had incident psychiatric disorders after. The total all-cause healthcare costs were higher for patients with psychiatric disorders compared to those without psychiatric disorders ($72,223 [SD: 94,646] vs $57,411 [SD: 81,088] per patient per year; adjusted cost ratio (ACR) [95%CI]: 1.18 [1.09-1.27], p<0.0001). Patients with incident psychiatric disorders had higher all-cause healthcare costs than those without psychiatric disorders (ACR:1.34 [1.25-1.43]; p<0.0001]) or with prevalent psychiatric disorders (ACR: 1.12 [1.05-1.18]; p<0.0003).

CONCLUSIONS: Psychiatric disorders are highly prevalent and substantially associated with increased healthcare costs among newly diagnosed patients with breast cancer. Incident psychiatric disorders had higher all-cause healthcare cost than those with prevalent or no psychiatric disorders.