背景:重度抑郁症(MDD)是一种使人衰弱且昂贵的疾病。这项分析描述了健康相关的生活质量(HRQoL),卫生保健资源利用(HCRU),以及MDD患者与无MDD患者之间的费用,以及跨MDD严重性级别。
方法:2019年全国健康与健康调查用于确定患有MDD的成年人,按疾病严重程度分层(轻微/轻度,中度,中度严重,严重),和那些没有MDD。结果包括HRQoL(简短表格-36v2健康调查,EuroQol五维视觉模拟量表,效用分数),HCCU(住院治疗,急诊科[ED]访问,医疗保健提供者[HCP]访问),以及年化平均直接医疗和间接(工作场所)成本。对患有MDD和先前药物治疗失败的参与者进行亚组分析。使用双变量分析和多变量回归模型评估参与者特征和研究结果,分别。
结果:队列包括10,710名患有MDD的参与者(轻度/轻度=5905;中度=2206;中度=1565;重度=1034)和52,687名没有MDD的参与者。患有MDD的参与者的HRQoL评分明显低于没有MDD的参与者(每次比较,P<0.001)。MDD严重程度增加与HRQoL降低相关。相对于没有MDD的参与者,MDD参与者报告了更多的HCP访视(2.72vs5.64;P<0.001)和ED访视(0.18vs0.22;P<0.001),但住院次数相似.HCRU随着MDD严重程度的增加而增加。尽管大多数MDD患者的严重程度为轻度/轻度至中度,与没有MDD的参与者相比,总的直接医疗和间接成本明显更高(分别为8814美元对6072美元和5425美元对3085美元,两者P<0.001)。直接和间接成本在所有严重程度上显著高于最低/轻度MDD(每次比较,P<0.05)。在先前MDD药物治疗失败的患者中(n=1077),与轻度/轻度MDD相比,严重程度增加与HRQoL显著降低和总间接成本较高相关.
结论:这些结果量化了与MDD和之前的MDD药物治疗失败相关的显著和不同的负担。
这项研究描述了与重度抑郁症相关的负担。要做到这一点,我们比较了一项全国健康调查中诊断为重度抑郁障碍的患者和未诊断为重度抑郁障碍的患者的结局.患有重度抑郁症的参与者进一步通过症状的严重程度来表征。第一个结果是与健康相关的生活质量,第二个结果是健康就诊量,比如住院的次数,急诊部门的访问,以及与医疗保健提供者的访问。最后,评估了医疗保健相关费用和工作场所相关费用.与没有重度抑郁症的调查参与者相比,患有重度抑郁症的参与者的健康相关生活质量评分较低。重度抑郁症的严重程度增加与健康相关的生活质量下降有关。与没有抑郁症的参与者相比,患有重度抑郁症的参与者还报告了更多的医疗保健提供者和急诊科就诊。尽管他们都报告了相似的住院次数。患有重度抑郁症的参与者的医疗保健相关费用和工作场所相关费用均高于没有重度抑郁症的参与者。与症状轻微/轻度相比,症状更严重的参与者的费用更高.在患有重度抑郁症并报告说他们目前的药物由于缺乏反应而取代了旧药物的参与者中,与轻度/轻度重度抑郁障碍相比,重度抑郁障碍的严重程度增加与健康相关生活质量评分显著降低和工作场所相关总费用显著升高.
BACKGROUND: Major depressive disorder (MDD) is a debilitating and costly condition. This analysis characterized the health-related quality of life (HRQoL), health care resource utilization (HCRU), and costs between patients with versus without MDD, and across MDD severity levels.
METHODS: The 2019 National Health and Wellness Survey was used to identify adults with MDD, who were stratified by disease severity (minimal/mild, moderate, moderately severe, severe), and those without MDD. Outcomes included HRQoL (Short Form-36v2 Health Survey, EuroQol Five-Dimension Visual Analogue Scale, utility scores), HCRU (hospitalizations, emergency department [ED] visits, health care provider [HCP] visits), and annualized average direct medical and indirect (workplace) costs. A subgroup analysis was conducted in participants with MDD and prior medication treatment failure. Participant characteristics and study outcomes were evaluated using bivariate analyses and multivariable regression models, respectively.
RESULTS: Cohorts comprised 10,710 participants with MDD (minimal/mild = 5905; moderate = 2206; moderately severe = 1565; severe = 1034) and 52,687 participants without MDD. Participants with MDD had significantly lower HRQoL scores than those without (each comparison, P < 0.001). Increasing MDD severity was associated with decreasing HRQoL. Relative to participants without MDD, participants with MDD reported more HCP visits (2.72 vs 5.64; P < 0.001) and ED visits (0.18 vs 0.22; P < 0.001) but a similar number of hospitalizations. HCRU increased with increasing MDD severity. Although most patients with MDD had minimal/mild to moderate severity, total direct medical and indirect costs were significantly higher for participants with versus without MDD ($8814 vs $6072 and $5425 vs $3085, respectively, both P < 0.001). Direct and indirect costs were significantly higher across all severity levels versus minimal/mild MDD (each comparison, P < 0.05). Among patients with prior MDD medication treatment failure (n = 1077), increasing severity was associated with significantly lower HRQoL and higher total indirect costs than minimal/mild MDD.
CONCLUSIONS: These results quantify the significant and diverse burdens associated with MDD and prior MDD medication treatment failure.
This study described the burdens associated with major depressive disorder. To accomplish this, we compared outcomes from a national health survey between patients who had a diagnosis of major depressive disorder and those who did not. Participants with major depressive disorder were further characterized by the severity of their symptoms. The first outcome was health-related quality of life and the second outcome was the amount of health visits, such as the number of hospitalizations, emergency department visits, and visits with health care providers. Finally, health care-related costs and workplace-related costs were evaluated. Survey participants with major depressive disorder had lower health-related quality of life scores compared with those without major depressive disorder. Increasing severity of major depressive disorder was linked with decreasing health-related quality of life. Participants with major depressive disorder also reported more health care provider and emergency department visits relative to participants without the disorder, although they both reported a similar number of hospitalizations. Both health care-related and workplace-related costs were higher in participants with major depressive disorder than in those without major depressive disorder, and costs were higher among participants with more severe symptoms compared with minimal/mild symptoms. Among participants who had major depressive disorder and reported that their current medication had replaced an old medication because of a lack of response, increasing major depressive disorder severity was associated with significantly lower health-related quality of life scores and higher total workplace-related costs versus minimal/mild major depressive disorder.