Sicras-Mainar Antoni, Blanca-Tamayo Milagrosa, Gutiérrez-Nicuesa Laura, Salvatella-Pasant Jordi, Navarro-Artieda Ruth
Dirección de Planificación, Badalona Serveis Assistencials S.A., Badalona, Barcelona, España.
Gac Sanit. 2010 Jan-Feb;24(1):13-9. doi: 10.1016/j.gaceta.2009.05.012. Epub 2009 Jul 30.
To determinate the impact of comorbidity, resource use and cost (healthcare and lost productivity) on maintenance of remission of major depressive disorder in a Spanish population setting.
We performed an observational, prospective, multicenter study using population databases. The inclusion criteria were age > or = 18 years, first depressive episode between January 2003 and March 2007, with antidepressant prescription >60 days after the first prescription and a follow-up of at least 18 months (study: 12 months; continuation: 6 months). Two subgroups were considered: patients with/without remission.
sociodemographic data, episodes, resource utilization bands, healthcare costs (direct) and lost productivity (indirect). Logistic regression and analysis of covariance (Bonferroni correction) were used for analysis.
A total of 4,572 patients were analyzed and 54.6% (95% confidence interval: 53.2-56.0%) were considered in remission. Patients in remission were younger (52.6 vs. 60.7), with a lower proportion of women (71.7% vs. 78.2%), and showed less general morbidity (6.2 vs. 7.7 episodes/year), lower resource utilization bands/year (2.7 vs. 3.0), fewer sick leave days (31.0 vs. 38.5) and shorter treatment duration (146.6 vs. 307.7 days); p<0.01. Lack of remission was associated with fibromyalgia (odds ratio [OR]=2.5), thyroid alterations (OR=1.3) and hypertension (OR=1.2); p<0.001. The annual healthcare cost was euro706.0 per patient in remission vs. euro1,108.3 without remission (p <0.001) and lost productivity was euro1,631.5 vs. euro2,024.2, respectively (p <0.001).
Patients not achieving remission showed higher morbidity, resources use, healthcare costs and, especially, productivity losses.
确定在西班牙人群中，合并症、资源利用及成本（医疗保健和生产力损失）对重度抑郁症缓解维持的影响。
我们利用人口数据库进行了一项观察性、前瞻性、多中心研究。纳入标准为年龄≥18岁，2003年1月至2007年3月期间首次抑郁发作，首次处方后抗抑郁药处方超过60天且随访至少18个月（研究期：12个月；延续期：6个月）。考虑两个亚组：缓解/未缓解患者。
社会人口统计学数据、发作情况、资源利用类别、医疗保健成本（直接）和生产力损失（间接）。采用逻辑回归和协方差分析（Bonferroni校正）进行分析。
共分析了4572例患者，54.6%（95%置信区间：53.2 - 56.0%）被认为处于缓解状态。缓解患者更年轻（52.6岁对60.7岁），女性比例更低（71.7%对78.2%），且总体发病率更低（每年6.2次对7.7次发作），每年资源利用类别更少（2.7对3.0），病假天数更少（31.0天对38.5天），治疗持续时间更短（146.6天对307.7天）；p<0.01。未缓解与纤维肌痛（优势比[OR]=2.5）、甲状腺改变（OR=1.3）和高血压（OR=1.2）相关；p<0.001。缓解患者的年度医疗保健成本为每位患者706.0欧元，未缓解患者为1108.3欧元（p<0.001），生产力损失分别为1631.5欧元和2024.2欧元（p<0.001）。
未实现缓解的患者发病率更高、资源利用更多、医疗保健成本更高，尤其是生产力损失更大。
