Department of Health Services Research, University of Texas M. D. Anderson Cancer Center, 1400 Pressler St, Unit 1444, Houston, TX, TX 77030, USA.
Division of Management, Policy and Community Health, University of Texas School of Public Health, Houston, TX, USA.
BMC Psychiatry. 2020 Mar 23;20(1):131. doi: 10.1186/s12888-020-02527-x.
Both depression and cancer are economically burdensome. However, how depression affects the healthcare expenditures of elderly cancer patients from payers' and patients' perspectives is largely unknown. This study investigated whether depression resulted in higher healthcare expenditures among these patients from both payers' and patients' perspectives and identified health service use categories associated with increased expenditures.
From the Medicare Current Beneficiary Survey (MCBS)-Medicare database, we identified breast, lung and prostate cancer patients aged 65 years and over who were newly diagnosed between 2007 and 2012. Presence of depression was based on self-reports from the surveys. We used generalized linear models (GLM) and two-part models to examine the impact of depression on healthcare expenditures during the first two years of cancer diagnosis controlling for a vast array of covariates. We stratified the analyses of total healthcare expenditures by healthcare services and payers.
Out of the 710 elderly breast, lung and prostate cancer patients in our study cohort, 128 (17.7%) reported depression. Individuals with depression had $11,454 higher total healthcare expenditures, $8213 higher medical provider expenditures and $405 higher other services expenditures compared to their counterparts without depression. Also, they were significantly more likely to have inpatient services. For payers, they incurred $8280 and $1270 higher expenditures from Medicare's and patients' perspectives, respectively.
Elderly cancer patients with depression have significantly higher healthcare expenditures from both payers' and patients' perspectives and over different expenditure types. More research is needed in depression screening, diagnosis and treatment for this population.
抑郁和癌症都给经济带来沉重负担。然而，从支付方和患者的角度来看，抑郁如何影响老年癌症患者的医疗保健支出，在很大程度上尚不清楚。本研究调查了抑郁是否会导致这些患者从支付方和患者的角度来看医疗保健支出增加，并确定与支出增加相关的卫生服务使用类别。
我们从医疗保险当前受益人调查（MCBS）-医疗保险数据库中确定了 2007 年至 2012 年间新诊断为乳腺癌、肺癌和前列腺癌且年龄在 65 岁及以上的患者。抑郁的存在基于调查中的自我报告。我们使用广义线性模型（GLM）和两部分模型，在控制大量协变量的情况下，检查抑郁对癌症诊断后两年内医疗保健支出的影响。我们按医疗服务和支付方对总医疗保健支出的分析进行分层。
在我们的研究队列中，710 名老年乳腺癌、肺癌和前列腺癌患者中，有 128 名（17.7%）报告患有抑郁。与没有抑郁的患者相比，患有抑郁的患者的总医疗保健支出高出 11454 美元，医疗服务提供者支出高出 8213 美元，其他服务支出高出 405 美元。此外，他们更有可能接受住院服务。对于支付方，从医疗保险和患者的角度来看，他们分别产生了 8280 美元和 1270 美元的更高支出。
患有抑郁的老年癌症患者的医疗保健支出从支付方和患者的角度来看都显著增加，并且在不同的支出类型中也是如此。需要对这一人群进行更多的抑郁筛查、诊断和治疗研究。
