Health care utilisation in treatment-resistant depression: a Swedish population-based cohort study
Health care utilisation in treatment-resistant depression: a Swedish population-based cohort study
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DOI：
10.1080/13651501.2021.2003405
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发表时间：
2021-11-29
影响因子：
3
通讯作者：
Reutfors, Johan
中科院分区：
文献类型：
--
作者：
Brenner, Philip;Nygren, Adam;Reutfors, Johan
目的比较难治性抑郁症（TRD）与非难治性抑郁症患者的医疗服务利用情况。方法瑞典全国登记册用于识别18-69岁的抑郁症患者和抗抑郁药治疗。对患者进行前瞻性随访，并定义为在第三次不同的连续治疗事件开始时发生TRD。16，329名确定的TRD患者中的每一位都与5名不符合TRD标准的抑郁症对照者相匹配。主要结局指标是住院总天数和门诊就诊次数，次要结局是与抑郁症或自杀未遂的主要诊断相关的HCU。结果TRD患者的全因住院治疗风险显著高于对照组（第1年校正风险比[aRR] 3.03 [95%CI 3.01-3.05]，1-3年aRR 2.15 [2.13-2.16]）。当主要诊断为抑郁症（第一年aRR 4.41 [4.36-4.45]）和自杀未遂后（第一年aRR 4.43 [4.26-4.60]），这种情况更为明显。TRD患者的门诊访视也明显更频繁（第一年aRR 2.05 [2.03-2.07]）。在整个随访期间，TRD患者的HCU较高。结论TRD患者的HCU可能比其他patients with depression.KEYPOINTS高两倍至四倍，这项基于登记的前瞻性研究调查了难治性抑郁症（TRD）患者与其他抑郁症患者相比的医疗保健利用率（HCU）。TRD患者在所有测量结果方面的HCU高出2 - 4倍，包括住院天数和门诊访视。HCU升高持续了三年多，但逐渐下降。这应该与TRD患者的成本增加和个人负担相对应。
Objective To investigate the health care utilisation (HCU) among patients with treatment-resistant depression (TRD) compared to patients with depression not meeting TRD criteria. Methods Nationwide Swedish registers were used to identify patients 18-69 years old with incident depression and antidepressant treatment. Patients were followed prospectively and defined as having TRD at start of the third distinct consecutive treatment episode. Each of the 16,329 identified TRD patients were matched with five comparators with depression not meeting criteria for TRD. Main outcome measure was total number of inpatient days and outpatient visits, and secondary outcome was HCU in connection with a main diagnosis of depression or suicide attempt. Results TRD patients had a significantly higher risk of all-cause inpatient care than comparators (first year adjusted risk ratio [aRR] 3.03 [95%CI 3.01-3.05], years 1-3 aRR 2.15 [2.13-2.16]). This was more pronounced when the main diagnosis was depression (first year aRR 4.41 [4.36-4.45]), and after suicide attempt (first year aRR 4.43 [4.26-4.60]). Outpatient visits were also markedly more frequent for patients with TRD (first year aRR 2.05 [2.03-2.07]). Higher HCU among TRD patients persisted throughout follow-up. Conclusions Patients with TRD may have a twofold to fourfold higher HCU than other patients with depression.KEYPOINTS This register-based prospective study investigated health care utilisation (HCU) among patients with treatment-resistant depression (TRD) compared to other patients with depression. Patients with TRD had a two to fourfold higher HCU regarding all measured outcomes, including inpatient hospital days and outpatient visits. The elevated HCU persisted for more than three years, although decreasing gradually. This should correspond to increased costs and individual burden for patients with TRD.