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美国产后抑郁症母亲的幼儿医疗资源利用和成本的匹配队列研究。

Matched cohort study of healthcare resource utilization and costs in young children of mothers with postpartum depression in the United States.

机构信息

Departments of Obstetrics & Gynecology, Pediatrics, Psychiatry and Population & Quantitative Health Sciences, University of Massachusetts Medical School/UMass Memorial Health Care, Worcester, MA, USA.

Health Economics Outcomes Research, Sage Therapeutics, Inc, Cambridge, MA, USA.

出版信息

J Med Econ. 2020 Feb;23(2):174-183. doi: 10.1080/13696998.2019.1679157. Epub 2019 Oct 25.

Abstract

To assess healthcare resource utilization (HRU) and costs in children of mothers with and without postpartum depression (PPD). Administrative claims data from the IBM Watson Health MarketScan Databases (2010-2016) were used. Women with live births (index date = delivery date) were identified and linked to their newborns. The mother-child pairs were divided into PPD and non-PPD exposure cohorts based on claims for depression, mood or adjustment disorders, or anxiety identified in the mother between 15 and 365 days after delivery. Mother-child pairs with PPD exposure were propensity score matched 1:3 to mother-child pairs without PPD exposure. Children were required to have 24 months of continuous health plan enrolment following delivery. Additional comparisons were performed between mother-child pairs with and without preterm delivery. Overall, 33,314 mother-child pairs with PPD exposure were propensity score matched to 102,364 mother-child pairs without PPD exposure. During the 24-month follow-up period, HRU across most service categories was significantly higher among children in the PPD exposure cohort than non-PPD exposure cohort. Among outpatient services, the percentages of children with a physician specialist service (68% versus 64%), early-intervention screening (40% versus 37%), and an emergency room visit (48% versus 42%) were greater in children of mothers with PPD (all  < .001). Furthermore, children of mothers with PPD incurred 12% higher total healthcare costs in the first 24 months of life compared to children of mothers without PPD ($24,572 versus $21,946;  < .001). After excluding mothers with preterm delivery, the proportion of children with ER visits, physician specialist services, and outpatient pharmacy claims was significantly higher in the PPD exposure cohort than non-PPD exposure cohort (all  < .001). The results of this analysis suggest that HRU and costs over the first 24 months of life in children of mothers with PPD exceeded that of children of mothers without evidence of PPD.

摘要

评估有和没有产后抑郁(PPD)的母亲的孩子的医疗资源利用(HRU)和成本。使用 IBM Watson Health MarketScan 数据库(2010-2016 年)的行政索赔数据。确定有活产(索引日期=分娩日期)的妇女,并将其与新生儿联系起来。根据母亲在分娩后 15 至 365 天期间的抑郁、情绪或调整障碍或焦虑的索赔,将母婴对分为 PPD 和非 PPD 暴露队列。PPD 暴露的母婴对按照倾向评分匹配 1:3 与无 PPD 暴露的母婴对匹配。要求儿童在分娩后连续 24 个月有健康计划参保。还在有和没有早产的母婴对之间进行了额外的比较。总体而言,有 33314 对 PPD 暴露的母婴对按照倾向评分匹配到 102364 对无 PPD 暴露的母婴对。在 24 个月的随访期间,PPD 暴露队列的儿童在大多数服务类别中的 HRU 明显高于非 PPD 暴露队列。在门诊服务中,患有儿科专家服务(68%对 64%)、早期干预筛查(40%对 37%)和急诊就诊(48%对 42%)的儿童比例在患有 PPD 的母亲的孩子中更高(均 <.001)。此外,与无 PPD 的母亲的孩子相比,患有 PPD 的母亲的孩子在生命的头 24 个月中产生的总医疗保健费用高出 12%(24572 美元对 21946 美元;<.001)。排除早产母亲后,PPD 暴露队列中患有急诊就诊、儿科专家服务和门诊药房索赔的儿童比例明显高于非 PPD 暴露队列(均<.001)。这项分析的结果表明,有 PPD 的母亲的孩子在生命的头 24 个月中的 HRU 和成本超过了没有 PPD 证据的母亲的孩子。

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