美国退伍军人事务部数据库中伴有急性自杀意念或行为的重度抑郁症的临床和经济负担。

Clinical and economic burden of major depressive disorder with acute suicidal ideation or behavior in a US Veterans Health Affairs database.

机构信息

Janssen Scientific Affairs, LLC, Titusville, NJ, USA.

STATinMED Research, Plano, TX, USA.

出版信息

Curr Med Res Opin. 2022 Sep;38(9):1603-1611. doi: 10.1080/03007995.2022.2081452. Epub 2022 Jun 30.

DOI:10.1080/03007995.2022.2081452

PMID:35670276

Abstract

OBJECTIVE

Although a high incidence of major depressive disorder (MDD) and an increased risk of suicide are observed among the veteran population, there are yet limited real-world data characterizing patients with MDD with acute suicidal ideation/behavior (MDSI) in the Veterans Health Administration (VHA) system. We assessed the clinical and economic burden, including comorbidities, treatment patterns, health care resource utilization, and health care costs, among veterans and their family members with MDSI within the VHA system.

METHODS

This retrospective, longitudinal analysis of VHA datasets (10/1/2015-3/31/2018) evaluated the clinical and economic burden associated with MDSI and compared this population with matched MDD alone (i.e. MDD diagnosis without acute suicidal ideation/behavior) and non-MDD (i.e. neither MDD nor acute suicidal ideation/behavior) cohorts.

RESULTS

Among 11,203 patients with MDSI, the proportions of patients who filled a prescription for ≥1 antidepressant during the 12-month pre- and 6-month post-periods were significantly higher compared with patients with MDD alone (53.7% vs 28.8%, .05; and 72.3% vs 44.1%, .05; respectively). During the 12-month pre-period, the MDSI cohort had the highest proportion of patients with ≥1 mental health-related inpatient visit compared with the MDD alone and non-MDD cohorts (13.2% vs 2.3% vs 1.4%, respectively; .05), and the highest mental health-related costs per patient ($8853 vs $1913 vs $1079, respectively). For the 6-month post-period, the MDSI cohort had the highest proportion of patients with ≥1 mental health-related inpatient visit compared with the MDD alone and non-MDD cohorts (60.4% vs 7.9% vs 0.8%, respectively; .05), and had the highest mental health-related costs per patient ($20,334 vs $4803 vs $545, respectively).

CONCLUSIONS

Findings demonstrate significant clinical and economic burden for those in the VHA system diagnosed with MDSI and highlight unmet needs and opportunities for improving the care of this vulnerable group.

摘要

目的

尽管退役军人中存在重度抑郁障碍（MDD）发病率高和自杀风险增加的情况，但退伍军人健康管理局（VHA）系统中，针对 MDD 伴急性自杀意念/行为（MDSI）患者的真实世界数据仍十分有限。我们评估了 VHA 系统中 MDSI 退伍军人及其家庭成员的临床和经济负担，包括合并症、治疗模式、医疗资源利用和医疗费用。

方法

本项基于退伍军人健康管理局数据集（10/1/2015-3/31/2018）的回顾性纵向分析评估了与 MDSI 相关的临床和经济负担，并将该人群与匹配的单纯 MDD（即无急性自杀意念/行为的 MDD 诊断）和非 MDD（即既无 MDD 也无急性自杀意念/行为）队列进行了比较。

结果

在 11203 例 MDSI 患者中，与单纯 MDD 患者相比，在 12 个月的预治疗期和 6 个月的后治疗期内，至少开具一种抗抑郁药处方的患者比例显著更高（53.7%比 28.8%， .05；72.3%比 44.1%， .05）。在 12 个月的预治疗期内，MDSI 队列与单纯 MDD 和非 MDD 队列相比，有最高比例的患者至少接受一次心理健康相关住院治疗（13.2%比 2.3%比 1.4%， .05），每位患者的心理健康相关费用也最高（8853 美元比 1913 美元比 1079 美元）。在后治疗期的 6 个月内，MDSI 队列与单纯 MDD 和非 MDD 队列相比，有最高比例的患者至少接受一次心理健康相关住院治疗（60.4%比 7.9%比 0.8%， .05），每位患者的心理健康相关费用也最高（20334 美元比 4803 美元比 545 美元）。