Asl Ali Abdollahi Najand, Imani Ali, Farahbakhsh Mostafa, Sarbakhsh Parvin
Health Economics Department, Tabriz Health Service Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran,
J Ment Health Policy Econ. 2025 Jun 1;28(2):51-58.
BACKGROUND: Considering the importance of depression and anxiety disorders in the new century and one of the important causes of disability and lost years worldwide and imposing a huge cost on the global economy, economic burden studies to determine the location of costs and the consumption of medical resources in recent years have contributed a lot to health policymaking. During the studies, it was found that the prevalence of these disorders increased significantly in Iran. This reason, along with the difference in the results of studies on the economic burden of depression and anxiety published in Iran in recent years, was one of the reasons for conducting a study of the economic burden related to these disorders in the East Azarbaijan province of Iran. METHOD: A retrospective, non-interventional, cross-sectional, social perspective study was conducted using a bottom-up approach for direct costs and a human capital approach for indirect costs. The data was collected from outpatients over the first four months of 2022 and from inpatients over the first nine months of the same year. Patients without age limits and suffering from at least one major depressive disorder (F32.0-F33.9), panic anxiety (F41.0), and generalized anxiety disorder (F41.1) and natives of East Azerbaijan province were included in the study. In the study for direct costs, the cost of measures that are paid directly in the process of diagnosis and treatment (medical and non-medical) were examined separately for outpatients and inpatients. For indirect costs, lost productivity due to absenteeism and premature death was calculated. For outpatients, a researcher's fee checklist form was made, and for the data of inpatients, the financial statement available in the medical file of the hospital's accounting system was used. Razi Tabriz and Imam Khomeini Benab hospitals and mental health centers of Tabriz were used as public centers, and specialist psychiatrists' offices of Tabriz were used as private centers. Patients with more than one comorbidity were excluded from the study. Total costs are reported at purchasing power parity rates. RESULTS: The data of 145 outpatients and 198 inpatients were analyzed to calculate the economic burden of MDD, Panic Anxiety, and GAD. The total economic burden for these disorders was obtained by 142.2 million purchasing power parity (ppp) dollars in 2022 for the East Azarbaijan province of Iran, with a population of more than 3.5 million people. The economic burden was divided into direct costs of 35.4 million dollars ppp and indirect costs of 106.79 million dollars ppp, representing 24.9% and 75.1%, respectively. The share of direct expenses of the outpatient group is 23.1% of this percentage, and the remaining 1.8% is for the inpatient group. In the case of indirect cost, from the percentage related to this sector, the share of lost productivity due to lost working days is 65.84%, and 9.26% is lost productivity due to premature death. For the outpatient group, the cost of medicine with 58.64% of the cost per person, and in the inpatient group, the cost of patient hoteling with 55.63%, and the visit of a psychiatrist with 20.34% of the direct cost per hospitalized person, the largest share of the direct costs of these people they assigned themselves. According to the method adopted in the study, the total cost showed the highest sensitivity to the GDP Per Capita (ppp) and the prevalence rate of anxiety and the prevalence rate of depression, respectively. CONCLUSION: Based on the results of the study, it is clear that indirect costs account for a significant share of the economic burden. Also, although the direct costs per inpatient are higher than the direct costs per outpatient, due to the difference in the number of outpatients and inpatients, the direct costs of the outpatient group have a larger share of the total cost of the disease. Considering the average age of patients and the large age gap to retirement age, health policymakers should take necessary measures to deal with and prevent the ever-increasing costs.
背景:鉴于抑郁症和焦虑症在新世纪的重要性,它们是全球残疾和寿命损失的重要原因之一,并给全球经济带来巨大成本,近年来关于确定成本位置和医疗资源消耗的经济负担研究对卫生政策制定做出了很大贡献。在研究过程中,发现这些疾病在伊朗的患病率显著增加。这一原因,以及近年来伊朗发表的关于抑郁症和焦虑症经济负担研究结果的差异,是在伊朗东阿塞拜疆省开展这些疾病相关经济负担研究的原因之一。 方法:采用自下而上的方法计算直接成本,采用人力资本方法计算间接成本,进行了一项回顾性、非干预性、横断面、社会视角研究。数据收集于2022年前四个月的门诊患者以及同年的前九个月的住院患者。年龄不限且患有至少一种重度抑郁症(F32.0 - F33.9)、惊恐焦虑症(F41.0)和广泛性焦虑症(F41.1)的东阿塞拜疆省本地患者纳入研究。在直接成本研究中,分别对门诊患者和住院患者检查诊断和治疗过程中直接支付的措施成本(医疗和非医疗)。对于间接成本,计算因旷工和过早死亡导致的生产力损失。对于门诊患者,制作了研究人员费用清单表格,对于住院患者的数据,使用医院会计系统医疗档案中的财务报表。大不里士的拉齐医院和伊玛目霍梅尼贝纳医院以及大不里士的心理健康中心被用作公共中心,大不里士的专科精神科医生办公室被用作私人中心。患有多种合并症的患者被排除在研究之外。总成本按购买力平价率报告。 结果:分析了145名门诊患者和198名住院患者的数据,以计算重度抑郁症、惊恐焦虑症和广泛性焦虑症的经济负担。2022年,伊朗东阿塞拜疆省这些疾病的总经济负担为1.422亿美元购买力平价,该省人口超过350万。经济负担分为直接成本3540万美元购买力平价和间接成本1.0679亿美元购买力平价,分别占24.9%和75.1%。门诊患者组的直接费用占该百分比的23.1%,其余1.8%为住院患者组。就间接成本而言,在该部门相关百分比中,因工作日损失导致的生产力损失占65.84%,因过早死亡导致的生产力损失占9.26%。对于门诊患者组,药品成本占人均成本的58.64%,对于住院患者组,患者住宿成本占55.63%,精神科医生诊疗费用占每位住院患者直接成本的20.34%,这些人将最大份额的直接成本归因于自身。根据研究采用的方法,总成本对人均国内生产总值(购买力平价)、焦虑症患病率和抑郁症患病率分别表现出最高的敏感性。 结论:根据研究结果,很明显间接成本在经济负担中占很大比例。此外,虽然每位住院患者的直接成本高于门诊患者,但由于门诊患者和住院患者数量的差异,门诊患者组的直接成本在疾病总成本中占更大份额。考虑到患者的平均年龄以及与退休年龄的较大差距,卫生政策制定者应采取必要措施应对和预防不断增加的成本。
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