PITTSBURGH – Medical costs and use of outpatient medical services are much greater among people with obsessive-compulsive disorder than among those with depression, according to the findings of a study that examined the differences in Florida Medicaid patients over a 9-year period.
The study, funded by Jazz Pharmaceuticals, looked at only those patients with “pure” OCD–that is, OCD uncomplicated by depression, bipolar disorder, or psychosis–and “pure” depression–depression in the absence of OCD, bipolar disorder, or psychosis. The findings suggest that much of the care for patients with OCD occurs in outpatient medical settings, said Cheryl S. Hankin, Ph.D., president and chief scientific officer of BioMedEcon Health, Economics, and Outcomes Research, Moss Beach, Calif.
Anecdotally, such OCD patients have appeared in a variety of medical settings, including primary care, dermatology (patients who compulsively pick at their skin or pull their hair), and in obstetrics (pregnant women who fear contamination or other harm to their unborn children), Dr. Hankin noted.
Of approximately 2.9 million Florida Medicaid enrollees during 1997–2006, 16,055 met the criteria for pure depression and 156 for pure OCD. Of those, 135 of the pure OCD patients were matched to 1,511 pure depression patients for sex, race/ethnicity, medical illness severity (Charlson index), and age/year at initial diagnosis.
During the 2 years after diagnosis of OCD or depression, median overall health care costs were more than three times higher in those with pure OCD ($25,666) than those with pure depression ($7,832). The differences were greater for pure OCD for both overall medical costs ($24,799 vs. $7056) and for overall psychiatric costs ($3390 vs. $943). Total inpatient costs did not differ between the two groups ($8,932 for pure OCD, $5,791 for pure depression). There were no psychiatric inpatient stays in either group, Dr. Hankin noted.
Despite matching for medical illness severity, total outpatient costs ($5,139 vs. $2,687) drove the cost differential, with most of that difference coming from outpatient medical costs ($4,820 vs. $2,525). Outpatient psychiatric costs between pure OCD ($220) and pure depression ($224) did not differ significantly. Total pharmacy costs were also significantly higher for the pure OCD patients ($5,741 vs. $2,548), the difference being driven mainly by psychiatric medication costs ($3,294 vs. $818), while the difference for other medical pharmacy costs did not differ significantly ($1,810 for pure OCD vs. $1,346 for pure depression).
Dr. Hankin and her associates are now investigating whether the pharmaceutical treatment of OCD is appropriate in primary care medical settings. Some data have suggested that 40%–50% of patients are treated inappropriately, either with the wrong drugs, for too short a duration, and/or at too low a dose.