Agarwal Parul, Sambamoorthi Usha
School of Pharmacy, Department of Pharmaceutical Systems and Policy, West Virginia University, Robert C. Byrd Health Sciences Center (North), Morgantown, WV, USA.
J Gen Intern Med. 2015 Dec;30(12):1803-11. doi: 10.1007/s11606-015-3393-4. Epub 2015 May 20.
Depression is common among individuals with osteoarthritis and leads to increased healthcare burden. The objective of this study was to examine excess total healthcare expenditures associated with depression among individuals with osteoarthritis in the US.
Adults with self-reported osteoarthritis (n = 1881) were identified using data from the 2010 Medical Expenditure Panel Survey (MEPS). Among those with osteoarthritis, chi-square tests and ordinary least square regressions (OLS) were used to examine differences in healthcare expenditures between those with and without depression. Post-regression linear decomposition technique was used to estimate the relative contribution of different constructs of the Anderson's behavioral model, i.e., predisposing, enabling, need, personal healthcare practices, and external environment factors, to the excess expenditures associated with depression among individuals with osteoarthritis. All analysis accounted for the complex survey design of MEPS.
Depression coexisted among 20.6 % of adults with osteoarthritis. The average total healthcare expenditures were $13,684 among adults with depression compared to $9284 among those without depression. Multivariable OLS regression revealed that adults with depression had 38.8 % higher healthcare expenditures (p < 0.001) compared to those without depression. Post-regression linear decomposition analysis indicated that 50 % of differences in expenditures among adults with and without depression can be explained by differences in need factors.
Among individuals with coexisting osteoarthritis and depression, excess healthcare expenditures associated with depression were mainly due to comorbid anxiety, chronic conditions and poor health status. These expenditures may potentially be reduced by providing timely intervention for need factors or by providing care under a collaborative care model.
抑郁症在骨关节炎患者中很常见，并导致医疗负担加重。本研究的目的是调查美国骨关节炎患者中与抑郁症相关的额外总医疗支出。
使用2010年医疗支出面板调查（MEPS）的数据识别自我报告患有骨关节炎的成年人（n = 1881）。在骨关节炎患者中，使用卡方检验和普通最小二乘回归（OLS）来检查有抑郁症和无抑郁症患者之间的医疗支出差异。回归后线性分解技术用于估计安德森行为模型的不同构成要素，即易患因素、促成因素、需求因素、个人医疗行为和外部环境因素，对骨关节炎患者中与抑郁症相关的额外支出的相对贡献。所有分析均考虑了MEPS的复杂调查设计。
20.6%的骨关节炎成年患者同时患有抑郁症。患有抑郁症的成年人平均总医疗支出为13,684美元，而没有抑郁症的成年人平均总医疗支出为9284美元。多变量OLS回归显示，与没有抑郁症的成年人相比，患有抑郁症的成年人医疗支出高出38.8%（p < 0.001）。回归后线性分解分析表明，有抑郁症和无抑郁症成年人之间支出差异的50%可由需求因素的差异来解释。
在同时患有骨关节炎和抑郁症的患者中，与抑郁症相关的额外医疗支出主要归因于合并焦虑、慢性病和健康状况不佳。通过对需求因素进行及时干预或采用协作护理模式提供护理，可能会减少这些支出。
