Association of Outpatient Behavioral Health Treatment With Medical and Pharmacy Costs in the First 27 Months Following a New Behavioral Health Diagnosis in the US

Abstract

Importance: Outpatient behavioral health treatment (OPBHT) is an effective treatment for behavioral health conditions (BHCs) that may also be associated with improved medical health outcomes, but evidence regarding the cost-effectiveness of OPBHT across a large population has not been established.

Objective: To investigate whether individuals newly diagnosed with a BHC who used OPBHT incurred lower medical and pharmacy costs over 15 and 27 months of follow-up compared with those not using OPBHT.

Design, setting, and participants: This retrospective cohort study of commercially insured individuals in the US was conducted using administrative insurance claims data for individuals newly diagnosed with 1 or more BHCs between January 1, 2017, and December 31, 2018. Data were examined using a 12-month period before BHC diagnosis and 15- and 27-month follow-up periods. Participants included individuals aged 1 to 64 years who received any OPBHT with or without behavioral medication or who did not receive OPBHT or behavioral medication in the 15 months following diagnosis. Data were analyzed from May to October 2021.

Exposures: Receipt of OPBHT both as a dichotomous variable and categorized by number of OPBHT visits.

Main outcomes and measures: The main outcome was the association between OPBHT treatment and 15- and 27-month medical and pharmacy costs, assessed using a generalized linear regression model with γ distribution, controlling for potential confounders.

Results: The study population included 203 401 individuals, of whom most were male (52%), White, non-Hispanic (75%), and 18 to 64 years of age (67%); 22% had at least 1 chronic medical condition in addition to a BHC. Having 1 or more OPBHT visits was associated with lower adjusted mean per-member, per-month medical and pharmacy costs across follow-up over 15 months (no OPBHT: $686 [95% CI, $619-$760]; ≥1 OPBHT: $571 [95% CI, $515-$632]; P < .001) and 27 months (no OPBHT: $464 [95% CI, $393-$549]; ≥1 OPBHT: $391 [95% CI, $331-$462]; P < .001). Furthermore, almost all doses of OPBHT across the 15 months following diagnosis were associated with lower costs compared with no OPBHT.

Conclusions and relevance: In this cohort study, medical cost savings were associated with OPBHT among patients newly diagnosed with a BHC in a large, commercially insured population. The findings suggest that promoting and optimizing OPBHT may be associated with reduced overall medical spending among patients with BHCs.

Figure 1.. Study Flow Diagram of Inclusions and Exclusions

OPBHT indicates outpatient behavioral health treatment.

Figure 2.. Posttreatment Adjusted Mean Medical and Pharmacy Costs at 15 Months and 27 Months Following Initial Diagnosis by Outpatient Behavioral Health Treatment (OPBHT) Levels and Age

Adjusted mean differences are expressed per member per month for individuals using OPBHT vs the reference category (no OPBHT visits). Data were adjusted for sex, household income, race and ethnicity, episode risk group score, medical and pharmacy costs in the 12 months prior to the first behavioral health diagnosis (preperiod), categorical behavioral health diagnoses, presence of chronic medical conditions, behavioral health insurance, and treatment characteristics (use of behavioral health drugs concurrent with OPBHT [treatment group only] and utilization of a higher level of care) during the 15-month diagnosis and treatment and follow-up periods. Whiskers indicate 95% CIs for the adjusted means. ^aSignificant difference vs no OPBHT for participants younger than 18 years. ^bSignificant difference vs no OPBHT for participants aged 18 to 25 years. ^cSignificant difference vs no OPBHT for participants aged 26 to 64 years.