The Accumulation of Healthcare, Benefit and Social Care Costs of Depression Before and After Diagnosis: A Six-Year Observational Cohort Study

The economic burden of depression substantially impacts health and social services. Estimating system-level costs is crucial for planning resource use, as well as designing healthcare systems and services aligned with value-based healthcare principles. However, translating these insights into effective and patient-centred care plans requires an understanding of individual-level total costs, distributions and key predictors before and after a depression diagnosis. This observational cohort study used data from 17 Finnish health and social care and benefits registers during 2014–2019 to investigate resource use in patients aged 18–79 years with a depression diagnosis recorded by specialised psychiatric care in the Helsinki-Uusimaa region in 2015. The total costs pre- and post-diagnosis were estimated for each patient using two generalised linear mixed models, assessing the impact of gender, age, socioeconomic status and number of psychiatric comorbidities. This study included 9926 patients. Following a depression diagnosis, total annual costs per patient more than doubled compared with the previous year (€18,789 versus €8575). Post-diagnosis, the total annual costs per patient decreased incrementally each year; by the end of the 5-year follow-up, total costs were 39% less than the first-year post-diagnosis, but still 28% more than pre-diagnosis. Key predictors of total costs included age and psychiatric comorbidities. Overall, 53% of costs were directly attributable to mental health and this proportion decreased during follow-up. The non-mental health costs, as well as benefit and pension costs (e.g. unemployment allowance), were considerable and stable during follow-up. To our knowledge, this is the first study to assess the dynamic effect of a depression diagnosis received in specialised psychiatric care on long-term costs from a societal perspective, including direct healthcare and social care and benefit and pension costs at the individual level. The findings suggest it may be valuable to account for the risk of future high and varied costs of benefits and pensions in the early stages post-diagnosis, as well as the impact of age and psychiatric comorbidities, when redesigning healthcare and social care services to ensure they are patient-centred, integrated and cost-effective.