Schulich Heart Centre, Division of Cardiology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
J Am Heart Assoc. 2017 Oct 11;6(10):e006911. doi: 10.1161/JAHA.117.006911.
Depression is strongly linked to increased morbidity and mortality in patients with chronic stable angina; however, its associated healthcare costs have been less well studied. Our objective was to identify the characteristics of chronic stable patients found to have depression and to determine the impact of an occurrence of depression on healthcare costs within 1 year of a diagnosis of stable angina.
In this population-based study conducted in Ontario, Canada, we identified patients diagnosed with stable angina based on angiogram between October 1, 2008, and September 30, 2013. Depression was ascertained by physician billing codes and hospital admission diagnostic codes contained within administrative databases. The primary outcome was cumulative mean 1-year healthcare costs following index angiogram. Generalized linear models were developed with a logarithmic link and γ distribution to determine predictors of cost. Our cohort included 22 917 patients with chronic stable angina. Patients with depression had significantly higher mean 1-year healthcare costs ($32 072±$41 963) than patients without depression ($23 021±$25 741). After adjustment for baseline comorbidities, depression was found to be a significant independent predictor of cost, with a cost ratio of 1.33 (95% confidence interval, 1.29-1.37). Higher costs in depressed patients were seen in all healthcare sectors, including acute and ambulatory care.
Depression is an important driver of healthcare costs in patients following a diagnosis of chronic stable angina. Further research is needed to understand whether improvements in the approach to diagnosis and treatment of depression will translate to reduced expenditures in this population.
抑郁与慢性稳定型心绞痛患者的发病率和死亡率增加密切相关；然而，其相关的医疗成本研究较少。我们的目的是确定患有抑郁的慢性稳定型患者的特征，并确定在稳定型心绞痛诊断后 1 年内发生抑郁对医疗保健成本的影响。
在加拿大安大略省进行的这项基于人群的研究中，我们根据 2008 年 10 月 1 日至 2013 年 9 月 30 日期间的血管造影结果确定了稳定型心绞痛患者。通过医生计费代码和行政数据库中包含的住院诊断代码确定抑郁。主要结果是在索引血管造影后 1 年内累积的平均医疗保健成本。使用对数链接和γ分布开发了广义线性模型，以确定成本的预测因素。我们的队列包括 22917 例慢性稳定型心绞痛患者。患有抑郁的患者的 1 年平均医疗保健费用（$32072 ± $41963）明显高于没有抑郁的患者（$23021 ± $25741）。在调整基线合并症后，发现抑郁是成本的一个重要独立预测因素，成本比为 1.33（95%置信区间，1.29-1.37）。在所有医疗保健领域，包括急性和门诊护理，抑郁患者的成本都较高。
抑郁是慢性稳定型心绞痛患者诊断后医疗保健成本的重要驱动因素。需要进一步研究以了解是否改善抑郁的诊断和治疗方法是否会降低该人群的支出。
