Baumeister Harald, Haschke Anne, Munzinger Marie, Hutter Nico, Tully Phillip J
Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr 41, D-79085 Freiburg, Germany ; Medical Psychology and Medical Sociology, Medical Faculty, University of Freiburg, Freiburg, Germany.
Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr 41, D-79085 Freiburg, Germany.
Biopsychosoc Med. 2015 Apr 17;9:11. doi: 10.1186/s13030-015-0039-z. eCollection 2015.
To systematically review in- and outpatient costs in patients with coronary artery disease (CAD) and comorbid mental disorders.
A comprehensive database search was conducted for studies investigating persons with CAD and comorbid mental disorders (Medline, EMBASE, PsycINFO, Psyndex, EconLit, IBSS). All studies were included which allowed a comparison of in- and outpatient health care costs (assessed either monetarily or in terms of health care utilization) of CAD patients with comorbid mental disorders (mood, anxiety, alcohol, eating, somatoform and personality disorders) and those without. Random effects meta-analyses were conducted and results reported using forest plots.
The literature search resulted in 7,275 potentially relevant studies, of which 52 met inclusion criteria. Hospital readmission rates were increased in CAD patients with any mental disorder (pooled standardized mean difference (SMD) = 0.34 [0.17;0.51]). Results for depression, anxiety and posttraumatic stress disorder pointed in the same direction with heterogeneous SMDs on a primary study level ranging from -0.44 to 1.26. Length of hospital stay was not increased in anxiety and any mental disorder, while studies on depression reported heterogeneous SMDs ranging from -0.08 to 0.82. Most studies reported increased overall and outpatient costs for patients with comorbid mental disorders. Results for invasive procedures were non-significant respectively inconclusive.
Comorbid mental disorders in CAD patients are associated with an increased healthcare utilization in terms of higher hospital readmission rates and increased overall and outpatient health care costs. From a health care point of view, it is requisite to improve the diagnosis and treatment of comorbid mental disorders in patients with CAD to minimize incremental costs.
系统评价冠心病（CAD）合并精神障碍患者的门诊和住院费用。
对研究CAD合并精神障碍患者的研究进行全面的数据库检索（Medline、EMBASE、PsycINFO、Psyndex、EconLit、IBSS）。纳入所有能够比较CAD合并精神障碍（情绪、焦虑、酒精、饮食、躯体形式和人格障碍）患者与无精神障碍患者的门诊和住院医疗费用（以货币形式评估或根据医疗服务利用情况评估）的研究。进行随机效应荟萃分析，并使用森林图报告结果。
文献检索得到7275项潜在相关研究，其中52项符合纳入标准。任何精神障碍的CAD患者的医院再入院率均升高（合并标准化均数差（SMD）=0.34[0.17；0.51]）。抑郁症、焦虑症和创伤后应激障碍的结果指向同一方向，主要研究水平上的异质性SMD范围为-0.44至1.26。焦虑症和任何精神障碍患者的住院时间未增加，而关于抑郁症的研究报告的异质性SMD范围为-0.08至0.82。大多数研究报告合并精神障碍患者的总体和门诊费用增加。侵入性操作的结果分别无统计学意义或不确定。
CAD患者合并精神障碍与较高的医院再入院率以及总体和门诊医疗费用增加导致的医疗服务利用增加有关。从医疗保健的角度来看，有必要改善CAD患者合并精神障碍的诊断和治疗，以尽量减少增量成本。
