Luppa Melanie, Heinrich Sven, Matschinger Herbert, Sandholzer Hagen, Angermeyer Matthias C, König Hans-Helmut, Riedel-Heller Steffi G
Department of Psychiatry, University of Leipzig, Johannisallee 20, D-04317 Leipzig, Germany.
J Affect Disord. 2008 Jan;105(1-3):195-204. doi: 10.1016/j.jad.2007.05.008. Epub 2007 Jun 12.
Depression in old age is common. Only few studies, exclusively conducted in the USA, have examined the impact of depression on direct costs in the elderly (60+). This study aims to determine the effect of depression on direct costs of the advanced elderly in Germany from a societal perspective.
451 primary care patients aged 75+ were investigated face-to-face regarding depressive symptoms (Geriatric Depression Scale), chronic medical illness (Chronic Disease Score) and resource utilisation and costs (cost diary). Resource utilisation was monetarily valued using 2004/2005 prices.
Mean annual direct costs of the depressed (euro5241) exceeded mean costs of non-depressed individuals (euro3648) by one third (p<.01). Significant differences were found for pharmaceutical costs, costs for medical supply and dentures, and for home care. Only few costs were caused by depression treatment. Depression has a significant impact on direct costs after controlling for age, gender, education, chronic medical illness and cognitive functions. A one-point increase in the GDS-Score was associated with a euro336 increase in the annual direct costs.
Reported costs can be considered as rather conservative estimates. There were no nursing home residents and no patients with dementia disorders in the sample. Furthermore, recall bias cannot be ruled out completely.
Depression in old age is associated with a significant increase of direct costs, even after adjustment for chronic medical illness. Future demographic changes in Germany will lead to an increase in the burden of old age depression. Therefore health policy should promote the development and use of cost-effective treatment strategies.
老年抑郁症很常见。仅有少数专门在美国开展的研究探讨了抑郁症对老年人（60岁及以上）直接成本的影响。本研究旨在从社会角度确定抑郁症对德国高龄老年人直接成本的影响。
对451名75岁及以上的初级保健患者进行了面对面调查，内容包括抑郁症状（老年抑郁量表）、慢性疾病（慢性病评分）以及资源利用和成本（成本日记）。资源利用按照2004/2005年价格进行货币估值。
抑郁症患者的年均直接成本（5241欧元）比非抑郁症患者的平均成本（3648欧元）高出三分之一（p<0.01）。在药品成本、医疗用品和假牙成本以及家庭护理方面发现了显著差异。抑郁症治疗导致的成本很少。在控制了年龄、性别、教育程度、慢性疾病和认知功能后，抑郁症对直接成本有显著影响。老年抑郁量表得分每增加1分，年均直接成本就增加336欧元。
报告的成本可被视为较为保守的估计。样本中没有养老院居民，也没有痴呆症患者。此外，不能完全排除回忆偏倚。
即使在对慢性疾病进行调整后，老年抑郁症仍与直接成本的显著增加相关。德国未来的人口结构变化将导致老年抑郁症负担增加。因此，卫生政策应促进具有成本效益的治疗策略的开发和应用。
