Analysis Group, Inc, New York, USA.
Am J Manag Care. 2011 Aug 1;17(8):e314-23.
To compare healthcare costs and resource utilization among patients with post-traumatic stress disorder (PTSD) vs control subjects with major depressive disorder (MDD) in populations covered by Medicaid or private insurance.
Retrospective analysis of Medicaid and private insurance administrative claims data.
Patients with at least 2 PTSD diagnoses during or after 1999, and at least 1 PTSD diagnosis during or after 2003, were identified from deidentified Medicaid claims from Florida, Missouri, and New Jersey (1999-2007) and from a privately insured claims database (1999-2008). Patients had continuous eligibility 6 months before (baseline) and 12 months after (study period) the index date and were aged 18 to 64 years. Potential control subjects having MDD without PTSD diagnosis were identified using similar selection criteria. Control subjects with MDD were matched to patients with PTSD on age, sex, state or region, employment status (private insurance only), index year, and race/ethnicity (Medicaid only). Study period per-patient utilization and costs, calculated as reimbursements to providers for medical services and prescription drugs, were compared using univariate and multivariate analyses.
Patients with PTSD had higher rates of other mental health disorders (eg, anxiety and bipolar disorder) and higher mental health-related resource use and costs than control subjects with MDD in both Medicaid and privately insured populations. The mean study period total direct healthcare costs were higher for patients with PTSD than for control subjects with MDD ($18,753 vs $17,990 for Medicaid and $10,960 vs $10,024 for private insurance, P <.05 for both). The difference in total direct costs was driven by higher mental health-related resource use for patients with PTSD.
Patients having PTSD had 4.2% to 9.3% higher mean annual per-patient healthcare costs compared with matched control subjects having MDD among patients covered by Medicaid or private insurance.
比较医疗补助计划或私人保险覆盖人群中患有创伤后应激障碍（PTSD）与患有重性抑郁障碍（MDD）的对照患者的医疗保健费用和资源利用情况。
对医疗补助计划和私人保险行政索赔数据进行回顾性分析。
从佛罗里达州、密苏里州和新泽西州的医疗补助计划（1999-2007 年）和私人保险索赔数据库（1999-2008 年）的匿名索赔中确定至少在 1999 年至 2003 年期间有 2 次以上 PTSD 诊断的患者，以及至少在 2003 年至 2008 年期间有 1 次以上 PTSD 诊断的患者。患者在索引日期前 6 个月（基线期）和 12 个月（研究期）内有持续资格，年龄在 18 至 64 岁之间。使用类似的选择标准确定没有 PTSD 诊断的患有 MDD 的潜在对照患者。使用多变量分析和单变量分析，根据年龄、性别、州或地区、就业状况（仅限私人保险）、索引年份和种族/民族（仅限医疗补助计划），对 PTSD 患者与 MDD 患者进行匹配。使用提供者提供的医疗服务和处方药报销计算每位患者的研究期内利用和成本，并进行比较。
在医疗补助计划和私人保险人群中，患有 PTSD 的患者比患有 MDD 的对照患者具有更高的其他心理健康障碍（如焦虑症和双相情感障碍）和更高的心理健康相关资源利用和费用。患有 PTSD 的患者的平均研究期内总直接医疗保健费用高于患有 MDD 的对照患者（医疗补助计划为 18753 美元，私人保险为 10960 美元，P 值均<0.05）。总直接费用的差异是由于 PTSD 患者的心理健康相关资源利用较高所致。
与医疗补助计划或私人保险覆盖的患有 MDD 的匹配对照患者相比，患有 PTSD 的患者每年的人均医疗保健费用平均高出 4.2%至 9.3%。
