Ren Bryan O, Khambete Pranav, Rasendran Chandruganesh, O'Donnell Jeffrey A, Ahn Nicholas U
Department of Orthopaedics, University Hospitals Cleveland Medical Center.
Case Western Reserve, School of Medicine, University, Cleveland, OH.
Clin Spine Surg. 2022 Apr 1;35(3):E374-E379. doi: 10.1097/BSD.0000000000001220.
This was a retrospective cross-sectional analysis.
The objective of this study was to estimate the incremental health care costs of depression in patients with spine pathology and offer insight into the drivers behind the increased cost burden.
Low back pain is estimated to cost over $100 billion per year in the United States. Depression has been shown to negatively impact clinical outcomes in patients with low back pain and those undergoing spine surgery.
Data was collected from the Medical Expenditure Panel Survey from 2007 to 2015. Spine patients were identified and stratified based on concurrent depression International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Health care utilization and expenditures were analyzed between patients with and without depression using a multivariate 2-part logistic regression with adjustments for sociodemographic characteristics and Charlson Comorbidity Index.
A total of 37,094 patients over 18 years old with a spine condition were included (mean expenditure: $7829±241.67). Of these patients, 7986 had depression (mean expenditure: $11,455.41±651.25) and 29,108 did not have depression (mean expenditure: $6837.89±244.51). The cost of care for spine patients with depression was 1.42 times higher (95% confidence interval, 1.34-1.52; P<0.001) than patients without depression. The incremental expenditure of spine patients with depression was $3388.22 (95% confidence interval, 2906.60-3918.96; P<0.001). Comorbid depression was associated with greater inpatient, outpatient, emergency room, home health, and prescription medication utilization and expenditures compared with the nondepressed cohort.
Spine patients with depression had significantly increased incremental economic cost of nearly $3500 more annually than those without depression. When extrapolated nationally, this translates to an additional $27.5 billion annually in incremental expenditures that can be attributed directly to depression among spine patients, which equates to roughly 10% of the total estimated spending on depression nationally. Strategies focused on optimizing the treatment of depression have the potential for dramatically reducing health care costs in spine surgery patients.
这是一项回顾性横断面分析。
本研究的目的是估计脊柱疾病患者抑郁症增加的医疗保健成本，并深入了解成本负担增加背后的驱动因素。
在美国，估计腰痛每年花费超过1000亿美元。抑郁症已被证明会对腰痛患者和接受脊柱手术的患者的临床结果产生负面影响。
从2007年至2015年的医疗支出面板调查中收集数据。根据国际疾病分类第九版临床修订版（ICD-9-CM）代码，识别脊柱患者并按并发抑郁症进行分层。使用多变量两部分逻辑回归分析有抑郁症和无抑郁症患者之间的医疗保健利用和支出情况，并对社会人口统计学特征和查尔森合并症指数进行调整。
共纳入37094名18岁以上的脊柱疾病患者（平均支出：7829±241.67美元）。在这些患者中，7986名患有抑郁症（平均支出：11455.41±651.25美元），29108名没有抑郁症（平均支出：6837.89±244.51美元）。患有抑郁症的脊柱患者的护理成本比没有抑郁症的患者高1.42倍（95%置信区间，1.34 - 1.52；P<0.001）。患有抑郁症的脊柱患者的增量支出为3388.22美元（95%置信区间，2906.60 - 3918.96；P<0.001）。与无抑郁症队列相比，合并抑郁症与更高的住院、门诊、急诊室、家庭健康和处方药利用及支出相关。
患有抑郁症的脊柱患者每年的增量经济成本比没有抑郁症的患者显著增加近3500美元。在全国范围内推断，这相当于每年额外增加275亿美元的增量支出，可直接归因于脊柱患者中的抑郁症，约占全国抑郁症估计总支出的10%。专注于优化抑郁症治疗的策略有可能大幅降低脊柱手术患者的医疗保健成本。
