Anxiety, Depression, and Stress Reaction/Adjustment Disorders and Their Associations with Healthcare Resource Utilization and Costs Among Newly Diagnosed Patients With Breast Cancer.
Dingwei Dai, Henriette Coetzer, Sean R Zion, Michael J Malecki
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引用次数: 0
Abstract
Background: Breast cancer is the most common cancer among women in the United States. Newly diagnosed patients with breast cancer often experience anxiety, depression, and stress. However, the impact of psychological distress on healthcare resource utilization (HCRU) and costs has not been adequately assessed. Objectives: To evaluate the incidence and prevalence of anxiety, depression, and stress reaction/adjustment disorder among patients newly diagnosed with breast cancer, to examine HCRU and costs, and to assess the association of these psychiatric disorders with costs. Methods: This retrospective observational cohort study was conducted using a large US administrative claims database with an index date of newly diagnosed breast cancer. Demographics and comorbidities (including anxiety, depression, and stress reaction/adjustment disorder) were assessed using data collected 12 months before and after the index date. HCRU and costs were assessed using data collected 12 months after the index date. Generalized linear regressions were performed to examine the association between healthcare costs and anxiety, depression, and stress reaction/adjustment disorder. Results: Of 6392 patients with newly diagnosed breast cancer, 38.2% were diagnosed with psychiatric disorders including anxiety (27.7%), depression (21.9%), or stress reaction/adjustment disorder (6%). The incidence of these psychiatric disorders was 15% and the prevalence was 23.2%. Patients with anxiety, depression, or stress reaction/adjustment disorder had higher rates of several types of HCRU (P < .0001) and higher total all-cause costs compared with patients without these psychiatric disorders (P < .0001). Patients with incident anxiety, depression, or stress reaction/adjustment disorder incurred higher all-cause costs in the first year following breast cancer diagnosis than those with prevalent anxiety, depression, or stress reaction/adjustment disorder (P < .0003), or those without these psychiatric disorders (P < .0001). Discussion: Of patients with anxiety, depression, or stress reaction/adjustment disorder, those with incident psychiatric disorders had higher healthcare costs, suggesting that new-onset psychological distress may contribute to higher costs incurred by the payer. Timely treatment of psychiatric disorders in this population may improve clinical outcomes and reduce HCRU and costs. Conclusions: Anxiety, depression, and stress reaction/adjustment disorder were common among patients newly diagnosed with breast cancer and were associated with increased healthcare costs in the first year following breast cancer diagnosis.
背景:乳腺癌是美国妇女最常见的癌症。新确诊的乳腺癌患者通常会感到焦虑、抑郁和压力。然而,心理困扰对医疗资源利用率(HCRU)和成本的影响尚未得到充分评估。研究目的评估新诊断为乳腺癌的患者中焦虑、抑郁和应激反应/适应障碍的发生率和患病率,检查 HCRU 和费用,并评估这些精神障碍与费用之间的关联。研究方法这项回顾性观察队列研究是通过一个大型的美国行政索赔数据库进行的,该数据库的索引日期为新诊断的乳腺癌。人口统计学和合并症(包括焦虑症、抑郁症和应激反应/适应障碍)通过索引日期前后 12 个月收集的数据进行评估。HCRU和费用则是通过索引日期后12个月收集的数据进行评估的。对医疗费用与焦虑症、抑郁症和应激反应/调整障碍之间的关系进行了广义线性回归分析。结果:在 6392 名新确诊的乳腺癌患者中,38.2% 的患者被诊断患有精神障碍,包括焦虑症(27.7%)、抑郁症(21.9%)或应激反应/适应障碍(6%)。这些精神障碍的发生率为 15%,患病率为 23.2%。焦虑症、抑郁症或应激反应/适应障碍患者患几种类型的 HCRU 的比例较高(P P P P P 讨论):在焦虑症、抑郁症或应激反应/适应障碍患者中,出现精神障碍的患者医疗费用更高,这表明新出现的心理困扰可能会导致支付方承担更高的费用。及时治疗这类人群的精神障碍可改善临床疗效,降低 HCRU 和费用。结论焦虑、抑郁和应激反应/适应障碍在新诊断为乳腺癌的患者中很常见,并且与乳腺癌诊断后第一年医疗费用的增加有关。