Department of Psychosomatic and Internal Medicine II, University of Heidelberg, Heidelberg, Germany.
J Psychosom Res. 2011 Feb;70(2):135-9. doi: 10.1016/j.jpsychores.2010.09.010. Epub 2010 Nov 18.
Although psychiatric comorbidity often goes undetected and untreated in cardiovascular patients, it is not clear whether the costs for a special treatment of psychiatric comorbidity are appropriately reflected in the reimbursement system. To investigate the economic impact of psychiatric comorbidity, we compared costs, returns, net gain, and duration of hospitalization in cardiovascular inpatients with and without psychiatric comorbidity.
For a period of 2 years, we analyzed costs, net gain, and other outcome variables according to the diagnosis-related group (DRG) system for cardiovascular inpatients of a German university department (n = 940). Psychiatric disorders were diagnosed by the treating physicians based on clinical criteria and results from the Patient Health Questionnaire (PHQ). With respect to the outcome variables, we compared patients with and without a psychiatric disorder, controlling for sociodemographic characteristics.
The average total costs of hospitalization (mean ± S.E.) for cardiovascular patients without psychiatric comorbidity and for patients with psychiatric comorbidity differed significantly (€5142 ± 210 vs. €7663 ± 571; d = 0.39). The increased costs for patients with psychiatric comorbidity were related to elevated returns, but the net gain for patients without psychiatric comorbidity was €277 ± 119. In contrast, the treatment of internal medicine patients with psychiatric disorders resulted in a net loss of -€624 ± 324 (overall group difference, d = -0.25).
Psychiatric comorbidity in cardiovascular inpatients leads to higher costs that are not reflected in the current reimbursement system in Germany. The inappropriate reimbursement of psychiatric comorbidity in cardiovascular inpatients may result in a serious undertreatment of these patients.
尽管心血管患者中经常存在未被发现和未得到治疗的精神共病，但目前尚不清楚针对精神共病的特殊治疗费用是否恰当地反映在报销系统中。为了研究精神共病的经济影响，我们比较了伴有和不伴有精神共病的心血管住院患者的成本、收益、净收益和住院时间。
在 2 年期间，我们根据德国一所大学附属医院心血管住院患者的诊断相关组（DRG）系统分析了成本、净收益和其他结果变量（n = 940）。精神障碍由主治医生根据临床标准和患者健康问卷（PHQ）的结果进行诊断。对于结果变量，我们比较了有和没有精神障碍的患者，同时控制了社会人口统计学特征。
无精神共病的心血管患者和有精神共病的心血管患者的住院总费用（平均值 ± S.E.）差异显著（€5142 ± 210 比 €7663 ± 571；d = 0.39）。有精神共病的患者的成本增加与收益增加有关，但无精神共病的患者的净收益为 €277 ± 119。相比之下，治疗有精神障碍的内科患者导致净损失 -€624 ± 324（总体组间差异，d = -0.25）。
心血管住院患者的精神共病会导致更高的成本，但这些成本在德国现行的报销系统中并未得到反映。对心血管住院患者的精神共病的报销不当可能导致这些患者的治疗严重不足。
