Treatment costs for depression with pain and cardiovascular comorbidities

Abstract

Objective: As depressive disorders are highly heterogeneous, and as patients exhibit wide differences in clinical characteristics and comorbidities, we aim to examine whether and how demographic and clinical correlates affect healthcare costs for patients with depression in a real-world setting. Method: A national cohort of adult patients (n=216,557) who received treatment for depression was identified from the National Health Insurance Research Database in Taiwan. Factors associated with service use and healthcare costs over a 12-month period were explored, with a particular focus on past treatment history, comorbid physical illnesses, painful physical symptoms, and choice of initial antidepressants. Results: Depression severity, past treatment history, comorbid mental/physical illnesses, painful physical symptoms, and choice of initial antidepressants were found to be associated with healthcare costs in the following year, although the nature of the associations differed across cost categories. The presence of comorbid cardiovascular disease or certain painful physical symptoms at baseline was associated not only with higher non-psychiatric but also with higher psychiatric costs; moreover, patients with these comorbidities were shown to have increased use of psychiatric emergency and inpatient services. Conclusion: Healthcare costs for depression are affected by a number of clinical characteristics and comorbidities of patients. The importance of comorbid pain and cardiovascular conditions warrants further research.

Impact of initial treatment outcome on long-term costs of depression: a 3-year nationwide follow-up study in Taiwan

“…Patients with PPS have been shown to be less likely to achieve remission following acute treatment for depression (Fava et al 2004), and our study concurs with these studies in finding that having certain PPS is associated with late recontacts even after a 6-month treatment-free status. Moreover, we previously found that the presence of baseline PPS consistently predicts higher 12-month healthcare costs of patients with depression (Pan et al 2013 a ), consistent with prior studies that patients with PPS and depression had higher service utilization and costs (Gameroff & Olfson, 2006). The current findings also showed that the presence of each kind of PPS at baseline is associated with an increase in total healthcare costs, not only in the first year but also in the second and third years.…”

“…Type of depression, past treatment history, co-morbid mental/physical illnesses, painful physical symptoms (PPS) and choice of initial antidepressants have been found to be associated with healthcare costs and service use for patients treated for depression in Taiwan (Pan et al . 2013 a ), hence the cost analysis conducted in the current study has taken these factors into account. Specific objectives of this study were to explore factors associated with initial outcome status and to examine healthcare costs over the following 3 years relative to this status.…”

Do multiple health events reduce resilience when compared with single events?

“…Though there are many possible explanations for this finding, including inflammatory processes that impact all comorbidities (Slavich & Irwin, 2014), and heightened allostatic load (Seeman et al, 2001), it appears this group is at greatest risk. Because health comorbidities are the rule rather than the exception in late life (Jaur & Stoddard, 1999), assessing depression continually in a primary care setting, as well as early intervention, will help to reduce the likelihood of adverse outcomes, and associated health care costs (Pan Knapp, Yeh, Chen, & McCrone, 2013). Additionally, it will help direct resources and treatment toward those individuals most likely to experience negative outcomes, as opposed to those who will not develop depression symptomatology (specifically, those in the Resilient class).…”

Impact of pain and remission in the functioning of patients with depression in Mainland China, Taiwan, and Hong Kong

“…Most studies have reported that patients with pain and depression have poorer overall response to treatment, longer hospitalizations (Bair et al, 2003), and reduced quality of life (Ang et al, 2009) than patients with only one of the conditions. Furthermore, the cooccurrence of these disorders has been associated with higher total health care costs in depression (Arnow et al, 2009) and newly diagnosed depression (Pan, Knapp, Yeh, Chen, & McCrone, 2013).…”