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A new study finds that depression-attributable costs paid by patients and their families are between two and 15 times greater than those covered by the health system alone.

British Columbians with severe depression pay $700 per week in out-of-pocket costs

January 15, 2024

by Jeff Hodson

This article originally appeared in 丁香园AV News and is reprinted with permission

Major depression costs B.C.'s health system more than $1.5 billion over two years, and people diagnosed with the illness are spending even more out of pocket to get treatment.

A new study, led by Sonya Cressman, an adjunct professor in 丁香园AV鈥檚 Faculty of Health Sciences, looked at the more than a quarter of a million British Columbian adults who were diagnosed with major depressive disorders (MDD) between 2015 and 2020.

Treating depression cost B.C.鈥檚 health system more than $1.5 billion over two years. However, the costs borne by the province are just a fraction of the total. The proportion of depression-attributable costs paid by patients and their families are between two and 15 times greater than those covered by the health system alone. Costs borne by patients are estimated to total $3 to $12 billion over those same two years, putting lower income patients at risk of financial hardship.

鈥淭he first few weeks of treatment after being diagnosed with serious depression in B.C. are critical for preventing financial hardship,鈥� said Cressman, a health economist who also has an appointment at the University of B.C.  鈥淟ow-income groups are paying disproportionately more than high-income groups once you take into consideration the basic costs of living. If depression goes into remission, then that inequality is erased. It鈥檚 mitigated by early and effective treatment.鈥�

Sonya Cressman, an adjunct professor in 丁香园AV's Faculty of Health Sciences.

Major depressive disorders are one of the most common mental illnesses. Over the next decade, depression is set to become the world鈥檚 leading cause of disability as it directly affects the patient鈥檚 ability to work.

Canadian health systems pay for MDD treatment through pharmaceutical therapies and visits to physicians, hospitals and emergency departments. However, the costs of psychotherapy or pharmacology treatments are not fully covered, nor do all Canadians have access to extended health benefits, meaning they must pay out-of-pocket. Other costs, like lost productivity and informal caregiving, are also borne by the patient and their family.

The study found that costs over the first 12 weeks after diagnosis are high but decrease if the depression is successfully managed. However, if the treatment is unsuccessful, those costs remain high and can become a financial burden, particularly for low-income households.

For example, in the first 12 weeks after diagnosis, a patient with severe depression will have health system costs averaging  $138/week, while simultaneously costing the patient and their family $735/week in depression-attributable costs. If treated successfully, those costs drop to $65/week for the health system and $80/week for the patient and their family. However, if treatment is unsuccessful, the cost to the health system reduces slightly to $125/week while the costs to patients and their family increases to $1,021/week.

The study also examined the distribution of expenditure proportions, the amount that is paid relative to a patient鈥檚 income, using a World Health Organization-defined threshold for financial hardship. It found that lower income groups and people in urban centres are more at risk of financial hardship. 

鈥淓ven in high-income Canada, our health-care systems come close to failing to meet their core objective of protecting patients from impoverishing health-related spending,鈥� said Cressman, adding that rapid access to effective treatments and achieving remission early could mitigate financial hardship for patients across income levels.

She hopes the study leads to national policy in Canada to protect patients with mental illness from the financial impacts of their condition. The study was nested within a project, jointly funded by Genome B.C., Genome Canada, and the Michael Smith Health Research B.C., to develop a genomic test to better predict early treatment to help reduce the costs to the health system and the patient.