The Excess Costs of Depression and the Influence of Sociodemographic and Socioeconomic Factors: Results from the German Health Interview and Examination Survey for Adults (DEGS)

Abstract

Introduction The aim of this study was to estimate excess costs of depression in Germany and to examine the influence of sociodemographic and socioeconomic determinants. Methods Annual excess costs of depression per patient were estimated for the year 2019 by comparing survey data of individuals with and without self-reported medically diagnosed depression, representative for the German population aged 18-79 years. Differences between individuals with depression (n = 223) and without depression (n = 4540) were adjusted using entropy balancing. Excess costs were estimated using generalized linear model regression with a gamma distribution and log-link function. We estimated direct (inpatient, outpatient, medication) and indirect (sick leave, early retirement) excess costs. Subgroup analyses by social determinants were conducted for sex, age, socioeconomic status, first-generation or second-generation migrants, partnership, and social support. Results Total annual excess costs of depression amounted to euro5047 (95% confidence interval [CI] 3214-6880) per patient. Indirect excess costs amounted to euro2835 (1566-4103) and were higher than direct excess costs (euro2212 [1083-3341]). Outpatient (euro498), inpatient (euro1345), early retirement (euro1686), and sick leave (euro1149) excess costs were statistically significant, while medication (euro370) excess costs were not. Regarding social determinants, total excess costs were highest in the younger age groups (euro7955 for 18-29-year-olds, euro9560 for 30-44-year-olds), whereas total excess costs were lowest for the oldest age group (euro2168 for 65+) and first-generation or second-generation migrants (euro1820). Conclusions Depression was associated with high excess costs that varied by social determinants. Considerable differences between the socioeconomic and sociodemographic subgroups need further clarification as they point to specific treatment barriers as well as varying treatment needs.