Depression Doubles Health Care Costs for Patients With Respiratory Conditions

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The analysis found 20% of people with asthma, emphysema, or chronic bronchitis also have depression.

Patients with respiratory conditions who also suffer from depression have much higher health care utilization and costs and require more complex care, according to a new report.

The study, published in the journal Pharmacy, offers a glimpse into the ways depression can complicate quality of life and health care for people with respiratory conditions.

Co-authors Prashant Sakharkar, PharmD, of Roosevelt University, and Thanh Mai, a PharmD candidate at Western New England University, explained that respiratory conditions place a significant burden on the US health care system, both in terms of mortality and in terms of health care expenditures. Chronic obstructive pulmonary disease (COPD) is now the fourth-leading cause of death in the United States, and it accounts for about $5 billion in US health care spending each year. Asthma, rates of which have been increasing, accounts for $7 billion in annual spending.

Existing evidence suggests that people who suffer from respiratory diseases, particularly COPD, are more likely to suffer from depression, Sakharkar and Mai wrote, and yet the data also show depression co-occurring with asthma or COPD is often under-treated or untreated.

In order to get a better understanding of links between depression and respiratory diseases, as well as their impact on the wider health care landscape, the authors crafted a study that examined health care utilization and costs of people with respiratory diseases with and without co-occurring depression.


Sakharkar and Mai looked at data from the Medical Expenditure Panel Survey, covering the years 2011-2017. They identified 8848 patients who had asthma, emphysema, or chronic bronchitis.

Overall, 1 in 5 patients in the sample (20%) had comorbid depression.

“Depressed individuals with respiratory conditions were more likely to be older, of the female gender, of white ethnicity, high school graduate, unmarried, and within a middle-income group,” Sakharkar and Mai wrote.

They were also more likely to have 2 or fewer chronic conditions, have private insurance, and report significant pain.

In terms of health care utilization, the investigators found individuals with depression and respiratory conditions had more ambulatory-care visits, more prescriptions filled, more emergency department visits, and more hospital inpatient days than their counterparts without depression.

That translated to roughly double the total health care expenditures, with people with depression spending an average of $24,532 over the course of the study, and those without spending $12,420. Those figures have been adjusted for inflation, the authors said.

The investigators said previous studies have varied widely when trying to estimate the prevalence of depression among patients with asthma and COPD.

“Although it is hard to draw conclusions based on these discrepancies, most of these findings suggest that there is an increased prevalence of depression in patients with asthma and COPD,” the authors wrote. “Our findings are well within the reported ranges.”

They said the largest contributors to health care costs among these individuals were ambulatory care, in-patient visits, and prescription drug costs. The presence of ambulatory care on that list differs from some earlier studies, but the investigators said that may be due to the fact that they included all physician and non-physician visits, in contrast to some earlier studies.

Sakharkar and Mai said the data suggest physicians should keep a careful eye out for depression among patients with respiratory conditions, particularly if their patients fall into high-risk categories.

“Aggressive treatment and follow-up for individuals with depression with respiratory conditions may provide greater benefits to these patients and are likely to reduce health care utilization and expenditure in the future,” they concluded.


Sakharkar P and Mai T. Co-occurring depression and associated healthcare utilization and expenditure in individuals with respiratory condition: a population-based study. Pharmacy (Basel). Published online September 25, 2021. doi:10.3390/pharmacy9040157