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

Published online by Cambridge University Press:  18 July 2013

Y.-J. Pan ,
M. Knapp  and
P. McCrone
Y.-J. Pan*
Affiliation:
Centre for the Economics of Mental and Physical Health, Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK Department of Psychiatry, Far Eastern Memorial Hospital, Taiwan Department of Public Health, School of Medicine, National Yang-Ming University, Taiwan
M. Knapp
Affiliation:
Centre for the Economics of Mental and Physical Health, Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK Personal Social Services Research Unit, LSE Health and Social Care, London School of Economics and Political Science, UK
P. McCrone
Affiliation:
Centre for the Economics of Mental and Physical Health, Health Service and Population Research Department, Institute of Psychiatry, King's College London, UK
*
*Address for correspondence: Dr Y.-J. Pan, Box 024, The David Goldberg Centre, De Crespigny Park, Denmark Hill, London SE5 8AF, UK. (Email: yi-ju.pan@kcl.ac.uk)
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Abstract

Background

The impact of initial treatment outcome on long-term healthcare costs in depression remains to be determined. We aimed to identify demographic and clinical characteristics associated with initial treatment outcomes and to test whether and how these outcomes influence total healthcare costs over the subsequent 3 years.

Method

In this secondary analysis of a large healthcare database, a national cohort of adult patients (n = 126 471) who received antidepressant treatment for depression was identified and factors associated with initial outcomes were examined. Potential predictors of total healthcare costs in the subsequent years were assessed using generalized linear modeling, with a particular focus on initial outcome status after antidepressant treatment and co-morbidities.

Results

Depression type and co-morbid painful physical symptoms (PPS) or mental illnesses were found to be associated with initial outcome status. Having sustained treatment-free status after initial treatment was shown to be associated with a 22–33% reduction in total healthcare costs in the second and third years (compared to those with late recontacts). Although the presence of co-morbid PPS was associated with higher healthcare costs, having certain co-morbid anxiety disorders was associated with lower costs over the 3 years.

Conclusions

Initial outcome status after antidepressant treatment has a sustained impact on individuals' total healthcare costs over the following 3 years. Future efforts to improve initial treatment outcome of depression are warranted.

Keywords

Costdepressionlongitudinal studytreatment outcome
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 6 , April 2014 , pp. 1147 - 1158
Copyright
Copyright © Cambridge University Press 2013 

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References

Aalten, P, de Vugt, ME, Jaspers, N, Jolles, J, Verhey, FR (2005). The course of neuropsychiatric symptoms in dementia. Part I: findings from the two-year longitudinal Maasbed study. International Journal of Geriatric Psychiatry 20, 523–530.CrossRefGoogle ScholarPubMed
Alonso, J, Angermeyer, MC, Bernert, S, Bruffaerts, R, Brugha, TS, Bryson, H, de Girolamo, G, Graaf, R, Demyttenaere, K, Gasquet, I, Haro, JM, Katz, SJ, Kessler, RC, Kovess, V, Lepine, JP, Ormel, J, Polidori, G, Russo, LJ, Vilagut, G, Almansa, J, Arbabzadeh-Bouchez, S, Autonell, J, Bernal, M, Buist-Bouwman, MA, Codony, M, Domingo-Salvany, A, Ferrer, M, Joo, SS, Martinez-Alonso, M, Matschinger, H, Mazzi, F, Morgan, Z, Morosini, P, Palacin, C, Romera, B, Taub, N, Vollebergh, WA (2004). Use of mental health services in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatrica Scandinavica. Supplementum 420, 47–54.Google Scholar
Bergh, S, Engedal, K, Roen, I, Selbaek, G (2011). The course of neuropsychiatric symptoms in patients with dementia in Norwegian nursing homes. International Psychogeriatrics 23, 1231–1239.CrossRefGoogle ScholarPubMed
Byford, S, Barrett, B, Despiegel, N, Wade, A (2011). Impact of treatment success on health service use and cost in depression: longitudinal database analysis. Pharmacoeconomics 29, 157–170.CrossRefGoogle Scholar
Chen, L, Yip, W, Chang, MC, Lin, HS, Lee, SD, Chiu, YL, Lin, YH (2007). The effects of Taiwan's national health insurance on access and health status of the elderly. Health Economics 16, 223–242.CrossRefGoogle ScholarPubMed
Fava, M, Mallinckrodt, CH, Detke, MJ, Watkin, JG, Wohlreich, MM (2004). The effect of duloxetine on painful physical symptoms in depressed patients: do improvements in these symptoms result in higher remission rates? Journal of Clinical Psychiatry 65, 521–530.CrossRefGoogle ScholarPubMed
Gameroff, MJ, Olfson, M (2006). Major depressive disorder, somatic pain, and health care costs in an urban primary care practice. Journal of Clinical Psychiatry 67, 1232–1239.CrossRefGoogle Scholar
IMF (2013). EconStats. Implied PPP conversion rate. World Economic Outlook (WEO) data (www.econstats.com/weo/V013.htm). Accessed 5 April 2013.Google Scholar
Katon, WJ (2003). Clinical and health services relationships between major depression, depressive symptoms, and general medical illness. Biological Psychiatry 54, 216–226.CrossRefGoogle ScholarPubMed
Keller, MB, Shapiro, RW (1981). Major depressive disorder. Initial results from a one-year prospective naturalistic follow-up study. Journal of Nervous and Mental Disease 169, 761–768.CrossRefGoogle ScholarPubMed
Lin, EH, Katon, WJ, VonKorff, M, Russo, JE, Simon, GE, Bush, TM, Rutter, CM, Walker, EA, Ludman, E (1998). Relapse of depression in primary care. Rate and clinical predictors. Archives of Family Medicine 7, 443–449.CrossRefGoogle ScholarPubMed
McCullagh, P, Nelder, J (1989). Generalized Linear Models. Chapman and Hall: London.CrossRefGoogle Scholar
Mojtabai, R, Olfson, M, Mechanic, D (2002). Perceived need and help-seeking in adults with mood, anxiety, or substance use disorders. Archives of General Psychiatry 59, 77–84.CrossRefGoogle ScholarPubMed
Pan, YJ, Knapp, M, McCrone, P (2012). Cost-effectiveness comparisons between antidepressant treatments in depression: evidence from database analyses and prospective studies. Journal of Affective Disorders 139, 113–125.CrossRefGoogle ScholarPubMed
Pan, YJ, Knapp, M, Yeh, LL, Chen, YP, McCrone, P (2013 a). Treatment costs for depression with pain and cardiovascular comorbidities. Journal of Psychiatric Research 47, 329–336.CrossRefGoogle ScholarPubMed
Pan, YJ, Liu, SK, Yeh, LL (2013 b). Factors affecting early attrition and later treatment course of antidepressant treatment of depression in naturalistic settings: an 18-month nationwide population-based study. Journal of Psychiatric Research 47, 916–925.CrossRefGoogle ScholarPubMed
Paykel, ES (1998). Remission and residual symptomatology in major depression. Psychopathology 31, 5–14.CrossRefGoogle ScholarPubMed
Rush, AJ, Wisniewski, SR, Zisook, S, Fava, M, Sung, SC, Haley, CL, Chan, HN, Gilmer, WS, Warden, D, Nierenberg, AA, Balasubramani, GK, Gaynes, BN, Trivedi, MH, Hollon, SD (2012). Is prior course of illness relevant to acute or longer-term outcomes in depressed out-patients? A STAR*D report. Psychological Medicine 42, 1131–1149.CrossRefGoogle ScholarPubMed
Savva, GM, Zaccai, J, Matthews, FE, Davidson, JE, McKeith, I, Brayne, C (2009). Prevalence, correlates and course of behavioural and psychological symptoms of dementia in the population. British Journal of Psychiatry 194, 212–219.CrossRefGoogle ScholarPubMed
Shapiro, RW, Keller, MB (1981). Initial 6-month follow-up of patients with major depressive disorder. a preliminary report from the NIMH collaborative study of the psychobiology of depression. Journal of Affective Disorders 3, 205–220.CrossRefGoogle ScholarPubMed
Sicras-Mainar, A, Blanca-Tamayo, M, Gutierrez-Nicuesa, L, Salvatella-Pasant, J, Navarro-Artieda, R (2010 a). Impact of morbidity, resource use and costs on maintenance of remission of major depression in Spain: a longitudinal study in a population setting. Gaceta Sanitaria 24, 13–19.CrossRefGoogle Scholar
Sicras-Mainar, A, Blanca-Tamayo, M, Gutierrez-Nicuesa, L, Salvatella-Pasant, J, Navarro-Artieda, R (2010 b). Clinical validity of a population database definition of remission in patients with major depression. BMC Public Health 10, 64.CrossRefGoogle ScholarPubMed
Simon, GE, Khandker, RK, Ichikawa, L, Operskalski, BH (2006). Recovery from depression predicts lower health services costs. Journal of Clinical Psychiatry 67, 1226–1231.CrossRefGoogle ScholarPubMed
Simon, GE, VonKorff, M, Barlow, W (1995). Health care costs of primary care patients with recognized depression. Archives of General Psychiatry 52, 850–856.CrossRefGoogle ScholarPubMed
Sobocki, P, Ekman, M, Agren, H, Runeson, B, Jonsson, B (2006). The mission is remission: health economic consequences of achieving full remission with antidepressant treatment for depression. International Journal of Clinical Practice 60, 791–798.CrossRefGoogle ScholarPubMed
van der Lem, R, van der Wee, NJ, van Veen, T, Zitman, FG (2011). The generalizability of antidepressant efficacy trials to routine psychiatric out-patient practice. Psychological Medicine 41, 1353–1363.CrossRefGoogle ScholarPubMed
Vos, T, Flaxman, AD, Naghavi, M, Lozano, R, Michaud, C, Ezzati, M, Shibuya, K, Salomon, JA, Abdalla, S, Aboyans, V, Abraham, J, Ackerman, I, Aggarwal, R, Ahn, SY, Ali, MK, Alvarado, M, Anderson, HR, Anderson, LM, Andrews, KG, Atkinson, C, Baddour, LM, Bahalim, AN, Barker-Collo, S, Barrero, LH, Bartels, DH, Basáñez, MG, Baxter, A, Bell, ML, Benjamin, EJ, Bennett, D, Bernabé, E, Bhalla, K, Bhandari, B, Bikbov, B, Bin Abdulhak, A, Birbeck, G, Black, JA, Blencowe, H, Blore, JD, Blyth, F, Bolliger, I, Bonaventure, A, Boufous, S, Bourne, R, Boussinesq, M, Braithwaite, T, Brayne, C, Bridgett, L, Brooker, S, Brooks, P, Brugha, TS, Bryan-Hancock, C, Bucello, C, Buchbinder, R, Buckle, G, Budke, CM, Burch, M, Burney, P, Burstein, R, Calabria, B, Campbell, B, Canter, CE, Carabin, H, Carapetis, J, Carmona, L, Cella, C, Charlson, F, Chen, H, Cheng, AT, Chou, D, Chugh, SS, Coffeng, LE, Colan, SD, Colquhoun, S, Colson, KE, Condon, J, Connor, MD, Cooper, LT, Corriere, M, Cortinovis, M, de Vaccaro, KC, Couser, W, Cowie, BC, Criqui, MH, Cross, M, Dabhadkar, KC, Dahiya, M, Dahodwala, N, Damsere-Derry, J, Danaei, G, Davis, A, De Leo, D, Degenhardt, L, Dellavalle, R, Delossantos, A, Denenberg, J, Derrett, S, Des Jarlais, DC, Dharmaratne, SD, Dherani, M, Diaz-Torne, C, Dolk, H, Dorsey, ER, Driscoll, T, Duber, H, Ebel, B, Edmond, K, Elbaz, A, Ali, SE, Erskine, H, Erwin, PJ, Espindola, P, Ewoigbokhan, SE, Farzadfar, F, Feigin, V, Felson, DT, Ferrari, A, Ferri, CP, Fèvre, EM, Finucane, MM, Flaxman, S, Flood, L, Foreman, K, Forouzanfar, MH, Fowkes, FG, Franklin, R, Fransen, M, Freeman, MK, Gabbe, BJ, Gabriel, SE, Gakidou, E, Ganatra, HA, Garcia, B, Gaspari, F, Gillum, RF, Gmel, G, Gosselin, R, Grainger, R, Groeger, J, Guillemin, F, Gunnell, D, Gupta, R, Haagsma, J, Hagan, H, Halasa, YA, Hall, W, Haring, D, Haro, JM, Harrison, JE, Havmoeller, R, Hay, RJ, Higashi, H, Hill, C, Hoen, B, Hoffman, H, Hotez, PJ, Hoy, D, Huang, JJ, Ibeanusi, SE, Jacobsen, KH, James, SL, Jarvis, D, Jasrasaria, R, Jayaraman, S, Johns, N, Jonas, JB, Karthikeyan, G, Kassebaum, N, Kawakami, N, Keren, A, Khoo, JP, King, CH, Knowlton, LM, Kobusingye, O, Koranteng, A, Krishnamurthi, R, Lalloo, R, Laslett, LL, Lathlean, T, Leasher, JL, Lee, YY, Leigh, J, Lim, SS, Limb, E, Lin, JK, Lipnick, M, Lipshultz, SE, Liu, W, Loane, M, Ohno, SL, Lyons, R, Ma, J, Mabweijano, J, MacIntyre, MF, Malekzadeh, R, Mallinger, L, Manivannan, S, Marcenes, W, March, L, Margolis, DJ, Marks, GB, Marks, R, Matsumori, A, Matzopoulos, R, Mayosi, BM, McAnulty, JH, McDermott, MM, McGill, N, McGrath, J, Medina-Mora, ME, Meltzer, M, Mensah, GA, Merriman, TR, Meyer, AC, Miglioli, V, Miller, M, Miller, TR, Mitchell, PB, Mocumbi, AO, Moffitt, TE, Mokdad, AA, Monasta, L, Montico, M, Moradi-Lakeh, M, Moran, A, Morawska, L, Mori, R, Murdoch, ME, Mwaniki, MK, Naidoo, K, Nair, MN, Naldi, L, Narayan, KM, Nelson, PK, Nelson, RG, Nevitt, MC, Newton, CR, Nolte, S, Norman, P, Norman, R, O'Donnell, M, O'Hanlon, S, Olives, C, Omer, SB, Ortblad, K, Osborne, R, Ozgediz, D, Page, A, Pahari, B, Pandian, JD, Rivero, AP, Patten, SB, Pearce, N, Padilla, RP, Perez-Ruiz, F, Perico, N, Pesudovs, K, Phillips, D, Phillips, MR, Pierce, K, Pion, S, Polanczyk, GV, Polinder, S, Pope, CA 3rd, Popova, S, Porrini, E, Pourmalek, F, Prince, M, Pullan, RL, Ramaiah, KD, Ranganathan, D, Razavi, H, Regan, M, Rehm, JT, Rein, DB, Remuzzi, G, Richardson, K, Rivara, FP, Roberts, T, Robinson, C, De Leòn, FR, Ronfani, L, Room, R, Rosenfeld, LC, Rushton, L, Sacco, RL, Saha, S, Sampson, U, Sanchez-Riera, L, Sanman, E, Schwebel, DC, Scott, JG, Segui-Gomez, M, Shahraz, S, Shepard, DS, Shin, H, Shivakoti, R, Singh, D, Singh, GM, Singh, JA, Singleton, J, Sleet, DA, Sliwa, K, Smith, E, Smith, JL, Stapelberg, NJ, Steer, A, Steiner, T, Stolk, WA, Stovner, LJ, Sudfeld, C, Syed, S, Tamburlini, G, Tavakkoli, M, Taylor, HR, Taylor, JA, Taylor, WJ, Thomas, B, Thomson, WM, Thurston, GD, Tleyjeh, IM, Tonelli, M, Towbin, JA, Truelsen, T, Tsilimbaris, MK, Ubeda, C, Undurraga, EA, van der Werf, MJ, van Os, J, Vavilala, MS, Venketasubramanian, N, Wang, M, Wang, W, Watt, K, Weatherall, DJ, Weinstock, MA, Weintraub, R, Weisskopf, MG, Weissman, MM, White, RA, Whiteford, H, Wiersma, ST, Wilkinson, JD, Williams, HC, Williams, SR, Witt, E, Wolfe, F, Woolf, AD, Wulf, S, Yeh, PH, Zaidi, AK, Zheng, ZJ, Zonies, D, Lopez, AD, Murray, CJ, AlMazroa, MA, Memish, ZA (2012). Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380, 2163–2196.CrossRefGoogle ScholarPubMed
Wetzels, RB, Zuidema, SU, de Jonghe, JF, Verhey, FR, Koopmans, RT (2010). Course of neuropsychiatric symptoms in residents with dementia in nursing homes over 2-year period. American Journal of Geriatric Psychiatry 18, 1054–1065.CrossRefGoogle Scholar
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