Robinson Rebecca L, Stephenson Judith J, Dennehy Ellen B, Grabner Michael, Faries Douglas, Palli Swetha Rao, Swindle Ralph W
Eli Lilly and Company, Indianapolis, IN.
HealthCore, Inc., Wilmington, DE.
Psychosomatics. 2015 May-Jun;56(3):274-85. doi: 10.1016/j.psym.2014.08.003. Epub 2014 Aug 20.
To assess the cost outcomes of patients with a history of depression and clinically significant fatigue.
Adults with ≥ 2 claims with depression diagnosis codes identified from the HealthCore Integrated Research Database were invited to participate in this study linking survey data with retrospective claims data (12-mo presurvey and postsurvey periods). Patient surveys included measures for depression (Quick Inventory of Depressive Symptomatology), fatigue (Fatigue Associated with Depression Questionnaire), anxiety (7-item Generalized Anxiety Disorder scale), sleep difficulty (Athens Insomnia Scale), and pain (Brief Pain Inventory). After adjusting for demographic and clinical characteristics using propensity scores, postsurvey costs were compared between patients with and without fatigue using nonparametric bootstrapping methods.
Of the 1982 patients who had completed the survey and had complete claims data, 653 patients had significant levels of fatigue. Patients with fatigue reported significantly higher scores, indicating greater severity, on measures of depression, pain, sleep difficulty, and anxiety (all p < 0.05). These patients also had higher levels of overall medication use and were more likely to have lower measures of socioeconomic status than patients without significant levels of fatigue (all p < 0.05). Mean annual total costs were greater for patients with fatigue than those without fatigue ($14,462 vs $9971, respectively, p < 0.001). These cost differences remained statistically significant after adjusting for clinical and demographic differences.
Clinically significant fatigue appears to add to the economic burden of depression. This reinforces the need for aggressive treatment of all symptoms and further examination of the variability of this relationship as patients approach remission.
评估有抑郁症病史且伴有具有临床意义的疲劳症状的患者的成本结果。
从HealthCore综合研究数据库中识别出有≥2次抑郁症诊断编码的成年人，邀请他们参与这项将调查数据与回顾性索赔数据（调查前和调查后12个月期间）相联系的研究。患者调查包括抑郁症测量（抑郁症状快速量表）、疲劳测量（与抑郁相关的疲劳问卷）、焦虑测量（7项广泛性焦虑障碍量表）、睡眠困难测量（雅典失眠量表）和疼痛测量（简明疼痛量表）。使用倾向得分调整人口统计学和临床特征后，采用非参数自助法比较有疲劳症状和无疲劳症状患者的调查后成本。
在1982名完成调查并拥有完整索赔数据的患者中，653名患者有显著程度的疲劳症状。有疲劳症状的患者在抑郁症、疼痛、睡眠困难和焦虑测量方面的得分显著更高，表明症状更严重（所有p<0.05）。与无显著疲劳症状的患者相比，这些患者的总体药物使用水平也更高，且社会经济地位测量得分更低的可能性更大（所有p<0.05）。有疲劳症状患者的年均总成本高于无疲劳症状患者（分别为14,462美元和9,971美元，p<0.001）。在调整临床和人口统计学差异后，这些成本差异仍具有统计学意义。
具有临床意义的疲劳似乎会增加抑郁症的经济负担。这强化了积极治疗所有症状的必要性，以及在患者接近缓解时进一步研究这种关系变异性的需求。
