老年医疗保险受益人中患有新发抑郁症且患有乳腺癌、结直肠癌或前列腺癌的患者的抑郁症治疗和医疗保健支出。
Depression treatment and healthcare expenditures among elderly Medicare beneficiaries with newly diagnosed depression and incident breast, colorectal, or prostate cancer.
机构信息
Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, WV, USA.
Department of Clinical Pharmacy, School of Pharmacy, King Saud University, Riyadh, Saudi Arabia.
出版信息
Psychooncology. 2017 Dec;26(12):2215-2223. doi: 10.1002/pon.4325. Epub 2017 Jan 24.
OBJECTIVES
Depression is associated with high healthcare expenditures, and depression treatment may reduce healthcare expenditures. However, to date, there have not been any studies on the effect of depression treatment on healthcare expenditures among cancer survivors. Therefore, this study examined the association between depression treatment and healthcare expenditures among elderly with depression and incident cancer.
METHODS
The current study used a retrospective longitudinal study design, the linked Surveillance, Epidemiology, and End Results-Medicare database. Elderly (≥66 years) fee-for-service Medicare beneficiaries with newly diagnosed depression and incident breast, colorectal, or prostate cancer (N = 1502) were followed for a period of 12 months after depression diagnosis. Healthcare expenditures were measured every month for a period of 12-month follow-up period. Depression treatment was identified during the 6-month follow-up period. The adjusted associations between depression treatment and healthcare expenditures were analyzed with generalized linear mixed model regressions with gamma distribution and log link after controlling for other factors.
RESULTS
The average 1-year total healthcare expenditures after depression diagnosis were $38 219 for those who did not receive depression treatment; $42 090 for those treated with antidepressants only; $46 913 for those treated with psychotherapy only; and $51 008 for those treated with a combination of antidepressants and psychotherapy. As compared to no depression treatment, those who received antidepressants only, psychotherapy only, or a combination of antidepressants and psychotherapy had higher healthcare expenditures. However, second-year expenditures did not significantly differ among depression treatment categories.
CONCLUSIONS
Among cancer survivors with newly diagnosed depression, depression treatment did not have a significant effect on expenditures in the long term.
目的
抑郁症与高额医疗支出相关，而抑郁症治疗可能会降低医疗支出。然而，迄今为止，尚未有研究探讨抑郁症治疗对癌症幸存者医疗支出的影响。因此，本研究调查了抑郁症治疗与老年新发抑郁症和癌症患者的医疗支出之间的关联。
方法
本研究采用回顾性纵向研究设计，即链接的监测、流行病学和最终结果-医疗保险数据库。新诊断患有抑郁症且患有乳腺癌、结直肠癌或前列腺癌的老年（≥66 岁）按服务收费的医疗保险受益人（N=1502）在抑郁症诊断后随访 12 个月。在 12 个月的随访期间，每月测量医疗支出。在 6 个月的随访期间确定抑郁症治疗情况。在控制其他因素后，使用具有伽马分布和对数链接的广义线性混合模型回归分析来分析抑郁症治疗与医疗支出之间的调整关联。
结果
在抑郁症诊断后 1 年内，未接受抑郁症治疗者的总医疗支出平均为 38219 美元；仅接受抗抑郁药治疗者为 42090 美元；仅接受心理治疗者为 46913 美元；接受抗抑郁药和心理治疗联合治疗者为 51008 美元。与未接受抑郁症治疗相比，仅接受抗抑郁药治疗、仅接受心理治疗或联合抗抑郁药和心理治疗的患者医疗支出更高。然而，在抑郁症治疗类别中，第二年的支出没有显著差异。
结论
在新发抑郁症的癌症幸存者中，抑郁症治疗在长期内对支出没有显著影响。
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