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Online ISSN: 1099-176X    Print ISSN: 1091-4358
The Journal of Mental Health Policy and Economics
Volume 15, Issue 3, 2012. Pages: 127-138
Published Online: 1 September 2012

Copyright © 2012 ICMPE.


 

Does Co-Morbid Depression Impact Diabetes Related Costs? Evidence from a Cross-Sectional Survey in a Low-Income Country

Raõzvan M. Chereches,1 Cristian M. Litan,2* Alina M. Zlati,3 Joan R. Bloom4

1MD, PhD, Babes-Bolyai University, Center for Health Policy and Public Health, Cluj Napoca, Romania
2PhD, Babes-Bolyai University, Faculty of Economics and Business Administration, Cluj Napoca, Romania
3MA, Open Minds, Center for Mental Health Research, Cluj Napoca, Romania
4PhD, University of California Berkeley, School of Public Health, Berkeley, CA, USA

* Correspondence to: Cristian M. Litan, 71 Traian Mosoiu St., Cluj Napoca, Romania.
Tel./Fax: +40-264402215
E-mail: cristian.litan@econ.ubbcluj.ro

Source of Funding: This work was financed directly by grant number 5 D43 TW005810-07, `Finance and Mental Health Services Training in Czech Republic/Central Europe,'' sponsored by the U.S. National Institutes of Health ``John E. Fogarty International Center''.

Abstract

In this study we estimated diabetes related costs and we analyzed their link with depression in Romania. Direct and indirect costs equally contributed to the total diabetes expenses, while the repartition of the cost burden between the public and private agents is nearly equal. These findings can be explained by culturally specific factors. The bivariate analysis of the depression-cost relationship reveals significant larger costs for major depression than for minor depression, and in turn larger costs for minor depression than for depression-free patients. When the pure effect of depression on diabetes costs was isolated by GLM regression techniques, major depression was found to significantly increase costs. The increase of diabetes related costs due to depression bears implications for health policies - screening and treatment of co-occurring depression in diabetes patients should become part of the diabetes treatment protocol.

 

Aims of the Study: The economic implications of co-morbid depression in patients with chronic medical disorders have been studied mainly in high-income countries. However, the applicability of such findings in developing countries cannot be assumed. In the present study we estimate diabetes related costs and explore the link between depression and diabetes related costs in Romania. In this former communist country, the general perception of practitioners and policy-makers is that psychological issues are far less important than medical concerns for patients with diabetes, a perception that may lead to the misallocation of already scarce resources.

Methods: Data related to costs of diabetes care and to co-morbid depression were collected from a sample of 1,171 diabetes patients at the Nutrition and Diabetes Center in Cluj-Napoca, Romania, using the Diabetes Costs Questionnaire (DCQ) and the Patient Health Questionnaire 9 (PHQ9). The gathered data were subjected to a bivariate analysis of the depression-cost relationship, as well as a regression analysis in order to isolate the effect of depression on diabetes related costs from the effect of covariates.

Results: Direct and indirect diabetes related costs equally contributed to the total costs. The repartition of the cost burden between the public system and private agents is nearly equal as well. The bivariate analysis of the depression-cost relationship reveals statistically significant larger diabetes related costs for patients with major depression than for patients with minor depression, and the latter have larger diabetes related costs than patients free of depression symptoms. When the pure effect of depression on diabetes related costs was isolated by means of regression techniques, the provisional diagnosis of major depression was found to significantly increase diabetes related costs.

Discussion: The equal distribution of diabetes related costs between direct and indirect measures, as well as the cost burden equally split between the public system and private agents can be explained by the costs of medication and the costs associated with time lost by the non-compensated caregivers. Consistent with Romanian cultural traditions, most of the patients rely on their relatives in an informal diabetes caregiving market for assistance. Alongside depression, the multivariate analysis revealed that factors such as Hungarian ethnicity, income, and number of years since diagnosis also significantly contribute to diabetes related costs.

Implications for Health Care Provision and Use: Findings that depression increases diabetes related costs bear potential implications for health policies and health care provision (i.e., the effect of depression on costs can be minimized by adequate recognition and treatment). As such, screening and treatment of co-occurring depression in diabetes patients should become part of the diabetes treatment protocol, not only in Romania but in other Central and Eastern European countries as well.


Received 3 October 2011; accepted 8 June 2012

Copyright 2012 ICMPE