Universität zu Köln

Wagner, Christoph J., Metzger, Florian G., Sievers, Christoph, Marschall, Ursula, L'hoest, Helmut, Stollenwerk, Bjoern and Stock, Stephanie (2016). Depression-related treatment and costs in Germany: Do they change with comorbidity? A claims data analysis. J. Affect. Disord., 193. S. 257 - 267. AMSTERDAM: ELSEVIER. ISSN 1573-2517

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Abstract

Background: Existing diverse bottom-up estimations of direct costs associated with depression in Germany motivated a detailed patient-level analysis of depression-related treatment (DRT),-costs (DRC) and Comorbidity. Methods: A large sickness fund's claims data was used to retrospectively identify patients aged 18-65 years with new-onset depression treatment between January 1st and February 15th 2010, and follow them until December 31st 2010, describe DRT, estimate associated DRC, and predict DRC with a generalised linear model. Results: A total of 18,139 patients were analysed. Mean direct DRC were 783. Predictors of DRC regarding psychiatric comorbidities were: Delusion, psychotic disorders and personality disorders (DRCratio 1.72), Alcohol/drug addiction (1.82), abuse of alcohol/drugs (1.57). Predictors of DRC regarding medical comorbidities were: Rheumatoid arthritis (0.77), atherosclerosis (0.65), pregnancy (0.66), and Osteoarthritis (1.87). Of all patients, 60.8% received their most intense/specialised DRT from a general practitioner, a medical specialist (23.7%), a psychotherapist (8.0%), a medical specialist and psychotherapist (2.9%), or in hospital (4.6%). Serious psychiatric comorbidity nearly tripled depression related hospitalisation rates. Limitations: Seasonal affective disorder and missing psychiatric outpatient clinic data must be considered. Conclusions: Estimated DRC are significantly below the assessment of the German national guideline. Differing definitions of observation period and cost attribution might explain differing German DRC results. Signs of hospital psychiatric comorbidity bias indicate overestimation of hospital DRC. Identified associations of DRC with certain medical diseases in older adults warrant further research. Up to one quarter of patients with severe depression diagnosis might lack specialist treatment. (C) 2015 Elsevier B.V. All rights reserved.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Wagner, Christoph J. UNSPECIFIED UNSPECIFIED UNSPECIFIED Metzger, Florian G. UNSPECIFIED UNSPECIFIED UNSPECIFIED Sievers, Christoph UNSPECIFIED UNSPECIFIED UNSPECIFIED Marschall, Ursula UNSPECIFIED UNSPECIFIED UNSPECIFIED L'hoest, Helmut UNSPECIFIED UNSPECIFIED UNSPECIFIED Stollenwerk, Bjoern UNSPECIFIED UNSPECIFIED UNSPECIFIED Stock, Stephanie UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-281462
DOI:	10.1016/j.jad.2015.12.068
Journal or Publication Title:	J. Affect. Disord.
Volume:	193
Page Range:	S. 257 - 267
Date:	2016
Publisher:	ELSEVIER
Place of Publication:	AMSTERDAM
ISSN:	1573-2517
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language MENTAL-HEALTH SURVEY; PRIMARY-CARE PATIENTS; LATE-LIFE DEPRESSION; GENERAL-POPULATION; SEASONAL-VARIATION; MINOR DEPRESSION; MAJOR DEPRESSION; UNITED-STATES; DISORDERS; BURDEN Multiple languages Clinical Neurology; Psychiatry Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/28146