Health-economic outcomes in hospital patients with medical-psychiatric comorbidity: A systematic review and meta-analysis

Abstract

BackgroundHospital inpatients often experience medical and psychiatric problems simultaneously. Although this implies a certain relationship between healthcare utilization and costs, this relationship has never been systematically reviewed.ObjectiveThe objective is to examine the extent to which medical-psychiatric comorbidities relate to health-economic outcomes in general and in different subgroups. If the relationship is significant, this would give additional reasons to facilitate the search for targeted and effective treatments for this complex population.MethodA systematic review in Embase, Medline, Psycinfo, Cochrane, Web of Science and Google Scholar was performed up to August 2016 and included cross-references from included studies. Only peer-reviewed empirical studies examining the impact of inpatient medical-psychiatric comorbidities on three health-economic outcomes (length of stay (LOS), medical costs and rehospitalizations) were included. Study design was not an exclusion criterion, there were no restrictions on publication dates and patients included had to be over 18 years. The examined populations consisted of inpatients with medical-psychiatric comorbidities and controls. The controls were inpatients without a comorbid medical or psychiatric disorder. Non-English studies were excluded.ResultsFrom electronic literature databases, 3165 extracted articles were scrutinized on the basis of title and abstract. This resulted in a full-text review of 86 articles: 52 unique studies were included. The review showed that the presence of medical-psychiatric comorbidity was related to increased LOS, higher medical costs and more rehospitalizations. The meta-analysis revealed that patients with comorbid depression had an increased mean LOS of 4.38 days compared to patients without comorbidity (95% CI: 3.07 to 5.68, I2 = 31%).ConclusionsMedical-psychiatric comorbidity is related to increased LOS, medical costs and rehospitalization; this is also shown for specific subgroups. This study had some limitations; namely, that the studies were very heterogenetic and, in some cases, of poor quality in terms of risk of bias. Nevertheless, the findings remain valid and justify the search for targeted and effective interventions for this complex population.

Association of voice and mental health diagnoses with differences in voice‐related care utilization

“…A previous systematic review of healthcare utilization showed that patients with (vs. without) depression had higher medical costs. 19 Another study observed that patients with somatizing (vs. nonsomatizing) disorders had twice the rate of outpatient and inpatient healthcare utilization and twice the annual medical costs. 10 It is possible that the differences we observe in utilization of services such as imaging may partially be related to patient distress that prompts providers to order additional testing or perform procedures as a way to supplement their evaluations and provide reassurance to concerned patients.…”

Navigating the New Landscape of Value-Based Care: An Example of Increasing Access, Improving Quality, and Reducing Costs Using the Unified Protocol

“…A primary goal of value-based care models is to reduce healthcare costs. A recent metaanalysis indicated that patients hospitalized for a somatic complaint with psychiatric comorbidity incurred higher medical costs, were more frequently re-hospitalized, and had longer lengths of stay than those without a psychiatric comorbidity (Jansen et al, 2018), suggesting effective treatment of psychiatric disorders could reduce system-wide healthcare costs. There is support for the greater cost-effectiveness of brief treatments, including cognitive-behavior therapy (CBT) for depression, relative to pharmacotherapy (Ross et al, 2019), and for similar levels of costeffectiveness relative to longer treatments for particular conditions and populations (e.g., Slade et al, 2017).…”

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