Comorbilidad y coste ambulatorio asociado a los pacientes con trastornos depresivos en un ámbito poblacional
2007
Objective: To study the impact of depressive disorders (DD) on
health care expenditure and to measure associated comorbidity in
patients in primary care settings (PCS) under normal clinical practice
conditions.
Method: A retrospective cohort study was carried out. The
study cohort consisted of outpatients aged over 14 years of age with
an established diagnosis of DD (ICPC; P76) treated in a PC health
centre during 2004. A comparative cohort was formed with the
remaining outpatients without DD, treated in that health centre.
Main factors for calculation were: age, gender, history/comorbidity
and health resource use and the corresponding outpatient costs;
drugs, diagnostic tests, visits to specialists and PC physicians. Multiple
logistic regression analysis and ANCOVA models were used in
order to adjust costs and comorbidities between the cohorts of
patients.
Results: A total of 64,072 subjects were assessed; 6,592
patients with DD [10.3% (CI: 8.2-12.4%), 74.5% (CI: 73.4%-
75.6%) females]. DD outpatients displayed a higher number of
episodes of comorbidities/year (mean ± SD; 7.4 ± 4.3 vs. 4.7 ±
3.3, p < 0.0001) and global medical visits/patient/year (12.0 ±
9.3 vs. 7.4 ± 7.6, p < 0.0001). The main comorbidities associated
to DD were neurological disorders [Odds ratio (95% CI); 2.1
(CI: 1.5-2.6), p < 0.0001], alcoholism [1.6 (CI: 1.3-1.9), p <
0.0001] and malignancies [1.3 (CI: 1.1-1.5), p < 0.0001]. DD
were associated with significantly higher adjusted total costs;
€ 1,083.8 (SEM; € 8.4) vs. € 684.1 (€ 3.4), p < 0.0001. Higher
costs were displayed for elderly patients. Sixty-two percent of
the total cost was related to drugs.
Conclusions: Prevalence of DD was higher, particularly in
women. Following adjustment in accordance with comorbidity,
age and sex, DD outpatients used more health care resources and
implied higher costs. Higher costs were associated with age.
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