Clinical Excellence Research Center, Stanford University School of Medicine, Center for Academic Medicine, Stanford, CA 94305, USA.
Ann Behav Med. 2023 Apr 22;57(5):380-385. doi: 10.1093/abm/kaac063.
Depression is a common comorbidity for patients with chronic medical conditions. Although the costs of treating chronic medical illness in combination with depression are believed to be significantly higher than the costs of treating each condition independently, few studies have formally modeled the cost consequences of mental health comorbidity.
To estimate the relative magnitude of the independent and synergistic contributions to health care costs from depression diagnosis and other chronic physical health conditions.
Cross-sectional, observational study using all individuals >18 years of age in the national Blue Cross Blue Shield (BCBS) Axis claims database (N = 43,872,144) from calendar year 2018. General linear models with and without interaction terms were used to assess the relative magnitude of independent and synergistic contributions to total annual health care costs of depression alone and in combination with coronary heart disease, chronic kidney disease, chronic obstructive pulmonary disease, diabetes (both types 1 and 2), hypertension, and arthritis.
The incremental annual cost associated with having a diagnosis of depression was $2,951 compared to $1,986-$6,251 for the other chronic physical conditions. The interaction between depression and chronic conditions accounted for less than one-hundredth of the amount of variation in costs explained by the main effects of depression and each chronic physical condition.
The independent increase in total annual health care costs associated with a depression diagnosis was comparable to that of many common physical chronic conditions. This finding underscores the importance of health care service and payment models that acknowledge depression as an equal contributor to overall health care costs. The combination of depression and another chronic condition did not synergistically increase total annual health care costs beyond the increases in costs associated with each condition independently. This finding has implications for simplifying risk adjustment models.
抑郁症是患有慢性疾病患者的常见合并症。虽然治疗合并抑郁症的慢性疾病的成本被认为明显高于单独治疗每种疾病的成本，但很少有研究正式评估心理健康合并症对成本的影响。
评估抑郁症诊断和其他慢性身体健康状况对医疗保健成本的独立和协同贡献的相对重要性。
使用 2018 年全国蓝十字蓝盾协会（BCBS）Axis 索赔数据库（N=43872144）中所有年龄大于 18 岁的个体进行横断面观察性研究。使用带有和不带有交互项的一般线性模型来评估抑郁症单独和与冠心病、慢性肾脏病、慢性阻塞性肺疾病、糖尿病（1 型和 2 型）、高血压和关节炎合并时对总年度医疗保健成本的独立和协同贡献的相对重要性。
与其他慢性身体状况相比，患有抑郁症的诊断的年增量成本为 2951 美元，而其他慢性身体状况的成本为 1986-6251 美元。抑郁症与慢性疾病之间的相互作用仅占抑郁症和每种慢性身体状况的主要效应解释成本变化的百分之一以下。
与抑郁症诊断相关的总年度医疗保健成本的独立增加与许多常见的慢性身体状况相当。这一发现强调了医疗保健服务和支付模式的重要性，这些模式承认抑郁症是整体医疗保健成本的同等贡献者。抑郁症和另一种慢性疾病的组合并没有协同增加总年度医疗保健成本，超过了每种疾病独立增加的成本。这一发现对简化风险调整模型具有影响。
