versión impresa ISSN 0213-9111
SICRAS-MAINAR, Antoni et al. Impact of morbidity, resource use and costs on maintenance of remission of major depression in Spain: a longitudinal study in a population setting. Gac Sanit [online]. 2010, vol.24, n.1, pp. 13-19. ISSN 0213-9111. http://dx.doi.org/10.1590/S0213-91112010000100003.
Objective: To determinate the impact of comorbidity, resource use and cost (healthcare and lost productivity) on maintenance of remission of major depressive disorder in a Spanish population setting. Methods: We performed an observational, prospective, multicenter study using population databases. The inclusion criteria were age >18 years, first depressive episode between January 2003 and March 2007, with antidepressant prescription >60 days after the first prescription and a follow-up of at least 18 months (study: 12 months; continuation: 6 months). Two subgroups were considered: patients with/without remission. Main measures: sociodemographic data, episodes, resource utilization bands, healthcare costs (direct) and lost productivity (indirect). Logistic regression and analysis of covariance (Bonferroni correction) were used for analysis. Results: A total of 4,572 patients were analyzed and 54.6% (95% confidence interval: 53.2-56.0%) were considered in remission. Patients in remission were younger (52.6 vs. 60.7), with a lower proportion of women (71.7% vs. 78.2%), and showed less general morbidity (6.2 vs. 7.7 episodes/year), lower resource utilization bands/year (2.7 vs. 3.0), fewer sick leave days (31.0 vs. 38.5) and shorter treatment duration (146.6 vs. 307.7 days); p<0.01. Lack of remission was associated with fibromyalgia (odds ratio [OR]=2.5), thyroid alterations (OR=1.3) and hypertension (OR=1.2); p<0.001. The annual healthcare cost was €706.0 per patient in remission vs. €1,108.3 without remission (p <0.001) and lost productivity was €1,631.5 vs. €2,024.2, respectively (p <0.001). Conclusions: Patients not achieving remission showed higher morbidity, resources use, healthcare costs and, especially, productivity losses.
Palabras llave : Major depressive disorder; Remission; Use of resources; Healthcare costs; Ambulatory care.