Date of Award


Document Type


Degree Name

Doctor of Philosophy (PhD)


Health Outcomes and Policy Research

Research Advisor

David K. Solomon, Pharm.D.


James E. Bailey, M.D. Lawrence M. Brown, Pharm.D. Ph.D. Brandi E. Franklin, Ph.D. George Relyea, M.S.


Anxiety Disorders, Medical Expenditure Panel Survey (MEPS), Cost of Illness, Direct Cost, Expenditure, Generalized Linear Model (GLM).


Background: Anxiety disorders are the most common psychiatric illness in the United States. However, economic burdens of this category of mental illnesses have not been well studied yet. The objective of this study was to estimate the societal cost of anxiety disorders for the ambulatory adult population of the U.S.

Data and Method: Data was collected from the 2009 and 2010 Medical Expenditure Panel Survey (MEPS), Bureau of Labor Statistics (BLS), and National Vital Statistics System (NVSS). Cost components included in the analyses were direct medical costs (i.e. cost for inpatient visits, outpatient visits, emergency room visits, office-based visits, prescription medications, and other services), and indirect cost (i.e. morbidity and mortality costs). Anxiety patients were identified using MEPS data. More specifically, individuals 18 years and older, who reported a diagnosis of, or had a medical event associated with anxiety disorder(s), were classified as anxiety population. Number of suicides due to anxiety disorders was estimated using the NVSS data. Direct medical costs attributable to anxiety disorders were estimated as the expenditures incurred by anxiety patients in excess of those incurred by anxiety-free population. Several multivariate regression analyses, using generalized linear models, were conducted to calculate the overall incremental direct medical costs associated with anxiety disorders, as well as cost by healthcare delivery setting, and cost for different sub-populations. Indirect costs were estimated using the Human Capital Approach (HCA). Morbidity cost was estimated by valuing the time period in which individuals had to stay in bed due to anxiety disorders. Mortality cost was estimated as the productivity loss from age at death to life expectancy.

Results: Among adult participants in 2009-2010 MEPS, 30.35 million (8.74%) reported being diagnosed with anxiety disorder(s). It was also estimated that in 2010, 3,497 suicides were due to anxiety disorders. The annual overall direct medical costs associated with anxiety disorders was estimated at $1657.52 per person (SE: $238.83; p <0.001), or $33.71 billion in total. Inpatient visits, prescription medications, and office-based visits together accounted for almost 93% of the overall cost. The increase in direct medical cost due to anxiety disorders was higher among White non-Hispanics ($1879.31) than Black non-Hispanics ($1459.30). For nonHispanics, anxiety was not associated with a statistically significant increase in medical expenditure. Regarding aspects of indirect cost, morbidity and mortality cost were estimated at $12.72 billion and $2.34 billion in 2013 US dollars, respectively. The 2013 societal cost of anxiety disorders was estimated at $48.72 billion.

Conclusion: The current study demonstrates conclusively that anxiety disorders, with the annual cost of $48.72 billion in 2013 US dollars, absorb a significant portion of US healthcare resources and should be prioritized by policymakers and healthcare providers who aim to reduce downstream costs of mental disorders.




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