Healthcare Expenditures and Utilization Associated with Vasomotor Symptoms and Depression Among Midlife Women in the United States: Evidence from the Medical Expenditure Panel Survey, 2017–2022

Background: During menopause, many women deal with a "double whammy" of hot flashes and depression. While we know each issue drives up doctor visits and costs, we still don't have a clear picture of the total financial toll when they occur together. Using nationwide U.S. data to break down this combined economic burden is an area that's wide open for more research. Methods: We conducted a retrospective cross-sectional analysis of pooled 2017–2022 Medical Expenditure Panel Survey (MEPS) data, including 22,042 U.S. women. Participants were categorized as VMS with depression, VMS without depression, or no VMS/no depression (reference). Outcomes included total annual healthcare expenditures, outpatient, emergency, and prescription expenditures, and healthcare utilization (outpatient visits, emergency department visits, inpatient hospitalizations). Survey-weighted generalized linear models with a gamma distribution and a log link were used for expenditures. In contrast, survey-weighted linear and count models were used for utilization, adjusting for demographic, socioeconomic, insurance, regional, year, and comorbidity burden. Results: Among 22,042 women, 529 (2.4%) had VMS with depression, and 268 (1.3%) had VMS without depression. The sample included 22,042 women with no VMS or depression, 529 with VMS and depression, and 268 with VMS without depression. Women with VMS and depression had the highest annual healthcare expenditures compared with women without VMS or depression. In multivariable analyses, women with VMS and depression had healthcare costs approximately 1.90 times higher than the reference group (β=0.64, SE=0.08, p< 0.0001; $11,404 vs. $6,002). Those with VMS without depression faced costs approximately 55% higher (β = 0.44, SE = 0.10, p < 0.0001; $9,303 vs. $6,002). Outpatient costs were also significantly higher among women with VMS and depression (β=0.31, SE=0.05, p< 0.0001), corresponding to approximately 36% higher outpatient costs over those with no VMS/no depression, respectively; $2,354 vs. $1,730). Women with both vasomotor symptoms (VMS) and depression had prescription drug spending that was about 2.61 times higher than those without VMS or depression (β = 0.96, SE = 0.13, p < 0.0001; $3.452 vs $1,323). Emergency department costs did not differ significantly between groups. Older age, unemployment, and higher comorbidity burden were also associated with increased healthcare costs. In utilization models, women with VMS and depression had 4.80 additional outpatient visits per year (SE = 0.50, p < 0.0001) and higher emergency department visit rates (β = 0.26, SE = 0.11, p < 0.05), corresponding to approximately 28% higher ER use, whereas inpatient hospitalizations were not significantly different. Women with VMS without depression also had more outpatient visits (β = 3.77, SE = 0.66, p < 0.0001) but no significant differences in emergency or inpatient utilization. Conclusions: VMS and depression are strong independent predictors of increased healthcare expenditures and outpatient utilization among midlife women in the United States. The excess economic burden is driven primarily by outpatient care and prescription use rather than hospitalization, suggesting that integrated menopause and mental health care may improve efficiency and reduce healthcare costs.