Clinical and economic burden of depression/anxiety in chronic obstructive pulmonary disease patients within a managed care population

  • Dalal A
  • Shah M
  • Lunacsek O
 et al. 
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Abstract

Background: Anxiety and depression are common co-morbidities that can complicate the course of chronic obstructive pulmonary disease (COPD). The purpose of this study was to evaluate their impact on healthcare utilization and costs in a managed care COPD population. Methods: Administrative claims data were used to conduct a retrospective cohort study of COPD patients ≥40 years of age, including those with co-morbid COPD-Depression (including anxiety). COPD-Depression patients were matched to COPD patients without depression (COPD-Only cohort) using propensity scores. Conditional logistic regression models assessed the 1-year risk of COPD exacerbations (i.e., emergency room [ER] visit/inpatient hospitalization) between cohorts. Differences in annual all-cause and COPD-related utilization/costs, along with 2-year costs, were also compared between the cohorts. Results: There were 3,761 patients per cohort. Patients in the COPD-Depression cohort were 77% more likely to have a COPD-related hospitalization (odds ratio [OR] = 1.77, P < 0.001), 48% more likely to have an ER visit (OR = 1.48, P < 0.001), and 60% more likely to have hospitalization/ER visit (OR = 1.60, P < 0.001) compared to the COPD-Only cohort. Average annual all-cause medical cost per patient was 23,759 for COPD-Depression vs 17,765 for COPD-Only (P < 0.001) and total (medical plus pharmacy) cost was 28,961 vs 22,512 (P < 0.001), respectively; corresponding average annual COPD-related medical cost was 2,040 vs 1,392 (P < 0.001) and total cost was 3, 185 vs 2,680 (P < 0.001). Similar trends were observed over the 2-year period. Conclusions: In the COPD population, patients with depression/anxiety have significantly higher risk of COPD exacerbations and annual all-cause and COPD-related costs than patients without these co-morbidities. These findings may have therapeutic implications and seem worthy of further exploration. © 2011 Informa Healthcare USA, Inc.

Author-supplied keywords

  • adult
  • aged
  • amfebutamone
  • anxiety disorder
  • arformoterol
  • article
  • beclometasone dipropionate
  • bronchodilating agent
  • budesonide
  • chronic obstructive lung disease
  • clinical evaluation
  • cohort analysis
  • comorbidity
  • controlled study
  • cost effectiveness analysis
  • depression
  • disease exacerbation
  • disease severity
  • female
  • flunisolide
  • fluticasone propionate
  • fluticasone proprionate plus salmeterol xinafoate
  • formoterol fumarate
  • health care cost
  • health care utilization
  • high risk population
  • hospital patient
  • human
  • ipratropium bromide
  • major clinical study
  • male
  • managed care
  • monoamine oxidase inhibitor
  • observational study
  • prescription
  • priority journal
  • psychopharmacotherapy
  • retrospective study
  • salbutamol
  • salmeterol xinafoate
  • scoring system
  • serotonin uptake inhibitor
  • tiotropium bromide
  • triamcinolone acetonide
  • tricyclic antidepressant agent
  • unclassified drug

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Authors

  • A A Dalal

  • M Shah

  • O Lunacsek

  • N A Hanania

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