Dennehy Ellen B, Robinson Rebecca L, Stephenson Judith J, Faries Douglas, Grabner Michael, Palli Swetha Rao, Stauffer Virginia L, Marangell Lauren B
Eli Lilly and Company , Indianapolis, IN , USA.
Curr Med Res Opin. 2015 Jun;31(6):1165-77. doi: 10.1185/03007995.2015.1029893. Epub 2015 May 12.
To determine the economic impact of sustained non-remission of depression on the total annual all-cause healthcare costs of patients with a history of depression.
Adults with ≥2 claims with depression diagnosis codes from the HealthCore Integrated Research Database were invited to participate in this retrospective/prospective fixed-cohort repeated-measures study. Patients with scores >5 at initial survey and 6 month assessment on the Quick Inventory of Depressive Symptomatology (QIDS-SR) were considered to be in 'sustained non-remission', while those with scores ≤5 at both assessments were considered to be in 'sustained remission'. Patients also completed self-report instruments to assess pain, fatigue, anxiety, sleep difficulty, and other health and wellness domains. Survey data were linked to patient claims (12 month pre- and post-initial-survey periods). After adjusting for demographic and clinical characteristics using propensity scores, post-survey costs and resource utilization were compared between remission and non-remission groups using non-parametric bootstrapping methods.
Of the 640 patients who met inclusion criteria, 140 (21.9%) were in sustained remission and 348 (54.5%) never achieved remission. Using propensity-score adjusted costs, sustained non-remission of depression was associated with higher annual healthcare expenditures of >$2300 per patient ($14,627 vs. $12,313, p = 0.0010) compared to remitted patients. Higher costs were associated with greater resource utilization and increased medication use. Non-remitters were prescribed more medications than remitters, including antidepressants and second-generation antipsychotics. Although length of antidepressant exposure over 12 months was similar, remitters were more likely to be adherent to antidepressants. Non-remission was associated with anxiety, pain, fatigue, sleep disruption, diabetes, anemia, obesity, and heavy drinking.
Failing to achieve remission of depression was associated with increased costs and greater resource utilization. Clinicians should strive to achieve sustained remission in patients with depression. Study limitations included reliance on claims data for initial identification of cohort and high rate of attrition in the analytic sample.
确定抑郁症持续未缓解对有抑郁症病史患者的年度全因医疗费用总额的经济影响。
邀请来自HealthCore综合研究数据库中诊断代码有≥2次抑郁症记录的成年人参与这项回顾性/前瞻性固定队列重复测量研究。在快速抑郁症状自评量表（QIDS-SR）初始调查和6个月评估中得分>5的患者被认为处于“持续未缓解”状态，而在两次评估中得分≤5的患者被认为处于“持续缓解”状态。患者还完成了自我报告工具，以评估疼痛、疲劳、焦虑、睡眠困难以及其他健康和幸福领域。调查数据与患者记录（初始调查前12个月和后12个月期间）相关联。在使用倾向得分调整人口统计学和临床特征后，使用非参数自抽样方法比较缓解组和未缓解组的调查后成本和资源利用情况。
在符合纳入标准的640名患者中，140名（21.9%）处于持续缓解状态，348名（54.5%）从未实现缓解。使用倾向得分调整后的成本，与缓解患者相比，抑郁症持续未缓解与每位患者每年超过2300美元的更高医疗支出相关（14627美元对12313美元，p = 0.0010）。更高的成本与更多的资源利用和增加的药物使用相关。未缓解患者比缓解患者开具了更多的药物，包括抗抑郁药和第二代抗精神病药。尽管12个月以上的抗抑郁药暴露时间相似，但缓解患者更有可能坚持服用抗抑郁药。未缓解与焦虑、疼痛、疲劳、睡眠障碍、糖尿病、贫血、肥胖和大量饮酒相关。
抑郁症未实现缓解与成本增加和更多的资源利用相关。临床医生应努力使抑郁症患者实现持续缓解。研究局限性包括依赖记录数据进行队列的初始识别以及分析样本中的高损耗率。
