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Impact of morbidity, resource use and costs on maintenance of remission of major depression in Spain: a longitudinal study in a population setting

Published: July 30, 2009
Category: Papers
Authors: Blanca-Tamayo M, Gutierrez-Nicuesa L, Navarro-Artieda R, Salvatella-Pasant J, Sicras-Mainar A
Country: Spain
Language: null
Type: Population Health
Setting: Hospital

Gac Sanit 24:13-19. Published in Spanish.

Dirección de Planificación, Badalona Serveis Assistencials S.A., Badalona, Barcelona, Spain

OBJECTIVE: To determinate the impact of comorbidity, resource use and cost (healthcare and lost productivity) on maintenance of remission of major depressive disorder in a Spanish population setting.

METHODS: We performed an observational, prospective, multicenter study using population databases. The inclusion criteria were age > or = 18 years, first depressive episode between January 2003 and March 2007, with antidepressant prescription >60 days after the first prescription and a follow-up of at least 18 months (study: 12 months; continuation: 6 months). Two subgroups were considered: patients with/without remission. Main measures: sociodemographic data, episodes, resource utilization bands, healthcare costs (direct) and lost productivity (indirect). Logistic regression and analysis of covariance (Bonferroni correction) were used for analysis.

RESULTS: A total of 4,572 patients were analyzed and 54.6% (95% confidence interval: 53.2-56.0%) were considered in remission. Patients in remission were younger (52.6 vs. 60.7), with a lower proportion of women (71.7% vs. 78.2%), and showed less general morbidity (6.2 vs. 7.7 episodes/year), lower resource utilization bands/year (2.7 vs. 3.0), fewer sick leave days (31.0 vs. 38.5) and shorter treatment duration (146.6 vs. 307.7 days); p<0.01. Lack of remission was associated with fibromyalgia (odds ratio [OR]=2.5), thyroid alterations (OR=1.3) and hypertension (OR=1.2); p<0.001. The annual healthcare cost was euro706.0 per patient in remission vs. euro1,108.3 without remission (p <0.001) and lost productivity was euro1,631.5 vs. euro2,024.2, respectively (p <0.001).

CONCLUSIONS: Patients not achieving remission showed higher morbidity, resources use, healthcare costs and, especially, productivity losses.

PMID: 19646795

Cost Burden Evaluation,Morbidity Pattern,Resource Use,Spain,Absenteeism,Adolescent,Aged,80 and over,Antidepressive Agents/economics,Antidepressive Agents/therapeutic use,Co-morbidity,Confidentiality,Cost of Illness,Depressive Disorder,Major/economics,Gender,Health Care Costs/statistics & numerical data,Health Resources/economics,Health Resources/utilization,Middle Aged,Models,Theoretical,Prescription Fees/statistics & numerical data,Prospective Studies,Spain/epidemiology,Young Adult

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