美国因重度抑郁症住院患者中难治性抑郁症的经济负担
Economic Burden of Treatment-Resistant Depression Among Patients Hospitalized for Major Depressive Disorder in the United States.
作者信息
Lin Jay, Szukis Holly, Sheehan John J, Alphs Larry, Menges Brandy, Lingohr-Smith Melissa, Benson Carmela
机构信息
Novosys Health Green Brook New Jersey.
Janssen Scientific Affairs Titusville New Jersey.
出版信息
Psychiatr Res Clin Pract. 2019 Oct 11;1(2):68-76. doi: 10.1176/appi.prcp.20190001. eCollection 2019 Oct.
OBJECTIVES
This study aimed to evaluate hospital length of stay (LOS) and cost as well as readmission risk and the associated economic burden among patients hospitalized for treatment-resistant and non-treatment-resistant major depressive disorder.
METHODS
Adult patients with a primary hospital discharge diagnosis of major depressive disorder were identified from the Premier Hospital Database (January 1, 2012-September 30, 2015). Patients were stratified into two cohorts: those whose hospital treatment was suggestive of treatment-resistant depression and those with non-treatment-resistant depression. Hospital LOS and cost during the initial admission and readmissions rates, LOS, and cost within the 6-month follow-up were compared between cohorts with a propensity score-matched sample.
RESULTS
After matching, 45,066 patients were included in each cohort. For index hospitalizations, mean hospital LOS was longer (7.4 vs. 5.9 days, p<0.001) and mean hospital cost higher ($8,681 vs. $6,632, p<0.001) for patients with treatment-resistant depression vs. non-treatment-resistant depression. Rates for all-cause (24.4% vs. 20.0%, p<0.001), major depressive disorder-related (17.0% vs. 13.3%, p<0.001), and suicidal ideation/suicide attempt-related (12.8% vs. 9.5%, p<0.001) readmissions were higher for patients with treatment-resistant depression. Mean LOS and total hospital costs per patient for readmissions were also greater for patients with treatment-resistant depression vs. non-treatment-resistant depression. Correspondingly, the combined hospital cost (index hospitalization+all-cause readmissions) was greater for patients with treatment-resistant depression ($12,370 vs. $9,429, p<0.001).
CONCLUSIONS
Treatment-resistant depression was associated with substantial economic burden among patients hospitalized for major depressive disorder. More-effective treatment and care for this patient population may reduce the hospital burden of patients with treatment-resistant depression.
目的
本研究旨在评估难治性和非难治性重度抑郁症住院患者的住院时间（LOS）、费用、再入院风险及相关经济负担。
方法
从Premier医院数据库（2012年1月1日至2015年9月30日）中确定以重度抑郁症为主出院诊断的成年患者。患者被分为两个队列：医院治疗提示为难治性抑郁症的患者和非难治性抑郁症患者。采用倾向得分匹配样本比较队列之间首次入院时的住院LOS和费用以及再入院率、LOS和6个月随访期内的费用。
结果
匹配后，每个队列纳入45,066例患者。对于首次住院，难治性抑郁症患者的平均住院LOS更长（7.4天对5.9天，p<0.001），平均住院费用更高（8681美元对6632美元，p<0.001）。难治性抑郁症患者的全因（24.4%对20.0%，p<0.001）、重度抑郁症相关（17.0%对13.3%，p<0.001）和自杀意念/自杀未遂相关（12.8%对9.5%，p<0.001）再入院率更高。难治性抑郁症患者再入院的平均LOS和每位患者的总住院费用也高于非难治性抑郁症患者。相应地，难治性抑郁症患者的综合住院费用（首次住院+全因再入院）更高（12370美元对9429美元，p<0.001）。
结论
难治性抑郁症在重度抑郁症住院患者中与巨大的经济负担相关。对该患者群体进行更有效的治疗和护理可能会减轻难治性抑郁症患者的医院负担。
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