Economic Impact of Subsequent Depression in Patients With a New Diagnosis of Stable Angina: A Population‐Based Study

Abstract

BackgroundDepression is strongly linked to increased morbidity and mortality in patients with chronic stable angina; however, its associated healthcare costs have been less well studied. Our objective was to identify the characteristics of chronic stable patients found to have depression and to determine the impact of an occurrence of depression on healthcare costs within 1 year of a diagnosis of stable angina.Methods and ResultsIn this population‐based study conducted in Ontario, Canada, we identified patients diagnosed with stable angina based on angiogram between October 1, 2008, and September 30, 2013. Depression was ascertained by physician billing codes and hospital admission diagnostic codes contained within administrative databases. The primary outcome was cumulative mean 1‐year healthcare costs following index angiogram. Generalized linear models were developed with a logarithmic link and γ distribution to determine predictors of cost. Our cohort included 22 917 patients with chronic stable angina. Patients with depression had significantly higher mean 1‐year healthcare costs ($32 072±$41 963) than patients without depression ($23 021±$25 741). After adjustment for baseline comorbidities, depression was found to be a significant independent predictor of cost, with a cost ratio of 1.33 (95% confidence interval, 1.29–1.37). Higher costs in depressed patients were seen in all healthcare sectors, including acute and ambulatory care.ConclusionsDepression is an important driver of healthcare costs in patients following a diagnosis of chronic stable angina. Further research is needed to understand whether improvements in the approach to diagnosis and treatment of depression will translate to reduced expenditures in this population.

Burden of Coronary Artery Disease and Peripheral Artery Disease: A Literature Review

“…CAD underlies a spectrum of conditions dependent on the degrees of stenosis, the hemodynamic consequences of the stenosis, plaque characteristics, and the level of myocardial ischemia [23,28]. Potential outcomes from CAD include major adverse CV events (MACE; CV death, MI, and stroke), heart failure, hospitalization, disability, and reduced activities of daily living (Table 1) [37][38][39][40]. MACE is a common outcome measure in studies of patients with CAD.…”

Healthcare utilization in patients with first‐time implantable cardioverter defibrillators (data from the WEBCARE study)

“…16 This increase was observed in several healthcare sectors after controlling for other healthcare expenditure costs (eg, physician costs, outpatient care, chronic care, inpatient care, and medications). 16 A possible mechanism underlying the association between depression and HCU is the association between depression and unhealthy lifestyle behaviors (eg, smoking, reduced exercise, unhealthy diet, alcohol consumption, and sedentary lifestyle), as depression is a known barrier for lifestyle changes, which may result in poor physical health and eventually in increased HCU. 17 In addition, patients with depression may experience associated somatic symptoms (eg, headaches, sleep disturbances) for which additional care is sought.…”

“…The current findings are in line with some previous studies in the general cardiac population that focused on HCU. For example, in patients with chronic stable angina, depression was an independent predictor of an increase in mean cumulative 1‐year healthcare costs, with a 33% increase in patients with depression as compared to non‐depressed patients . This increase was observed in several healthcare sectors after controlling for other healthcare expenditure costs (eg, physician costs, outpatient care, chronic care, inpatient care, and medications) .…”

“…For example, in patients with chronic stable angina, depression was an independent predictor of an increase in mean cumulative 1‐year healthcare costs, with a 33% increase in patients with depression as compared to non‐depressed patients . This increase was observed in several healthcare sectors after controlling for other healthcare expenditure costs (eg, physician costs, outpatient care, chronic care, inpatient care, and medications) . A possible mechanism underlying the association between depression and HCU is the association between depression and unhealthy lifestyle behaviors (eg, smoking, reduced exercise, unhealthy diet, alcohol consumption, and sedentary lifestyle), as depression is a known barrier for lifestyle changes, which may result in poor physical health and eventually in increased HCU .…”

Affective Disorders and Quality of Life in Patients With Coronary Heart Disease According to Psychometric Tests Data

“…О р и г и н а л ь н ы е и с с л е д о в а н и я Обсуждение Анализ современных исследований, данных нескольких метаанализов свидетельствует о том, что аффективные расстройства (тревога, депрессия, стресс) являются независимыми предикторами развития и неблагоприятного течения КБС [3,11,12]. Так, по данным регистра кардиологической помощи провинции Онтарио установлено, что у пациентов со СС, страдающих депрессией, отмечали 2-кратное повышение риска смерти (ОР 1,83; ДИ 1,62-2,07) и более высокий риск развития инфаркта миокарда (ОР 1,36; ДИ 1,10-1,67) по сравнению с пациентами без депрессии [13]. А учитывая то, что НС часто предшествует инфаркту миокарда и внезапной смерти, необходим учет влияния факторов, в том числе и психосоциальных, на течение и прогноз КБС [14].…”