Impact of the COVID-19 pandemic on treatment for mental health needs: a perspective on service use patterns and expenditures from commercial medical claims data

Abstract

Objective: To examine changes in use patterns, cost of healthcare services before and after the outbreak of the COVID-19 pandemic, and their impacts on expenditures for patients receiving treatment for depression, anxiety, eating disorders, and substance use.

Methods: This cross-sectional study employed statistical tests to analyze claims in MarketScan® Commercial Database in March 2020-February 2021 and quarterly from March 2020 to August 2021, compared to respective pre-pandemic periods. The analysis is based on medical episodes created by the Merative™ Medical Episode Grouper (MEG). MEG is a methodology that groups medical and prescription drug claims to create clinically relevant episodes of care.

Results: Comparing year-over-year changes, proportion of patients receiving anxiety treatment among all individuals obtaining healthcare services grew 13.7% in the first year of the pandemic (3/2020-2/2021) versus 10.0% in the year before the pandemic (3/2019-2/2020). This, along with a higher growth in price per episode (5.5% versus 4.3%) resulted in a greater increase in per claimant expenditure ($0.61 versus $0.41 per month). In the same periods, proportion of patients receiving treatment for depression grew 3.7% versus 6.9%, but per claimant expenditure grew by same amount due to an increase in price per episode (4.8%). Proportion of patients receiving treatment for anorexia started to increase 21.1% or more in the fall of 2020. Patient proportion of alcohol use in age group 18-34 decreased 17.9% during the pandemic but price per episode increased 26.3%. Patient proportion of opioid use increased 11.5% in March-May 2020 but decreased or had no significant changes in subsequent periods.

Conclusions: We investigated the changes in use patterns and expenditures of mental health patients before and after the outbreak of the COVID-19 pandemic using claims data in MarketScan®. We found that the changes and their financial impacts vary across mental health conditions, age groups, and periods of the pandemic. Some changes are unexpected from previously reported prevalence increases among the general population and could underlie unmet treatment needs. Therefore, mental health providers should anticipate the use pattern changes in services with similar COVID-19 pandemic disruptions and payers should anticipate cost increases due, in part, to increased price and/or service use.

Keywords: COVID-19; Depression; Eating disorders; Healthcare cost; Services utilization; Substance use.

Fig. 1

Distribution of patients by age group and gender

Fig. 2

(a) and (b): excess change and excess financial impact of change in patient proportion (PCR) of depression and generalized anxiety disorder episodes by age group in the pandemic period 3/2020–2/2021 when compared to the baseline in the pre-pandemic period 3/2019–2/2020. (c) and (d): same for anorexia nervosa and bulimia nervosa episodes. (e) and (f): same for alcohol and opioid abuse episodes

Fig. 3

(a) and (b): excess change and excess financial impact of change in patient proportion (PCR) of depression and generalized anxiety disorder episodes in six periods during the pandemic when compared to the baseline in the respective periods before the pandemic. (c) and (d): same for anorexia nervosa and bulimia nervosa episodes. (e) and (f): same for alcohol and opioid abuse episodes