Health care costs before and after diagnosis of depression in patients with unexplained pain: a retrospective cohort study using the United Kingdom General Practice Research Database
Catherine Reed,1 Jihyung Hong,2 Diego Novick,1 Alan Lenox-Smith,3 Michael Happich41Global Health Outcomes, Eli Lilly and Company, Windlesham, Surrey, UK; 2Personal Social Services Research Unit, London School of Economics and Political Science, London, UK; 3Eli Lilly UK, Basingstoke, UK; 4Eli Lilly...
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doaj-724ee1c8697c4a009585f05984dccfeb2020-11-24T20:59:12ZengDove Medical PressClinicoEconomics and Outcomes Research1178-69812013-01-012013default3747Health care costs before and after diagnosis of depression in patients with unexplained pain: a retrospective cohort study using the United Kingdom General Practice Research DatabaseReed CHong JNovick DLenox-Smith AHappich MCatherine Reed,1 Jihyung Hong,2 Diego Novick,1 Alan Lenox-Smith,3 Michael Happich41Global Health Outcomes, Eli Lilly and Company, Windlesham, Surrey, UK; 2Personal Social Services Research Unit, London School of Economics and Political Science, London, UK; 3Eli Lilly UK, Basingstoke, UK; 4Eli Lilly and Company, Bad Homburg, GermanyPurpose: To assess the impact of pain severity and time to diagnosis of depression on health care costs for primary care patients with pre-existing unexplained pain symptoms who subsequently received a diagnosis of depression.Patients and methods: This retrospective cohort study analyzed 4000 adults with unexplained pain (defined as painful physical symptoms [PPS] without any probable organic cause) and a subsequent diagnosis of depression, identified from the UK General Practice Research Database using diagnostic codes. Patients were categorized into four groups based on pain severity (milder or more severe; based on number of pain-relief medications and use of opioids) and time to diagnosis of depression (≤1 year or >1 year from PPS index date). Annual health care costs were calculated (2009 values) and included general practitioner (GP) consultations, secondary care referrals, and prescriptions for pain-relief medications for the 12 months before depression diagnosis and in the subsequent 2 years. Multivariate models of cost included time period as a main independent variable, and adjusted for age, gender, and comorbidities.Results: Total annual health care costs before and after depression diagnosis for the four patient groups were higher for the groups with more severe pain (£819–£988 versus £565–£628; P < 0.001 for all pairwise comparisons) and highest for the group with more severe pain and longer time to depression diagnosis in the subsequent 2 years (P < 0.05). Total GP costs were highest in the group with more severe pain and longer time to depression diagnosis both before and after depression diagnosis (P < 0.05). In the second year following depression diagnosis, this group also had the highest secondary care referral costs (P < 0.01). The highest drug costs were in the groups with more severe pain (P < 0.001), although costs within each group were similar before and after depression diagnosis.Conclusion: Among patients with unexplained pain symptoms, significant pain in combination with longer time from pain symptoms to depression diagnosis contribute to higher costs for the UK health care system.Keywords: depression, pain, cost, GPRD, UKhttp://www.dovepress.com/health-care-costs-before-and-after-diagnosis-of-depression-in-patients-a11944 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Reed C Hong J Novick D Lenox-Smith A Happich M |
spellingShingle |
Reed C Hong J Novick D Lenox-Smith A Happich M Health care costs before and after diagnosis of depression in patients with unexplained pain: a retrospective cohort study using the United Kingdom General Practice Research Database ClinicoEconomics and Outcomes Research |
author_facet |
Reed C Hong J Novick D Lenox-Smith A Happich M |
author_sort |
Reed C |
title |
Health care costs before and after diagnosis of depression in patients with unexplained pain: a retrospective cohort study using the United Kingdom General Practice Research Database |
title_short |
Health care costs before and after diagnosis of depression in patients with unexplained pain: a retrospective cohort study using the United Kingdom General Practice Research Database |
title_full |
Health care costs before and after diagnosis of depression in patients with unexplained pain: a retrospective cohort study using the United Kingdom General Practice Research Database |
title_fullStr |
Health care costs before and after diagnosis of depression in patients with unexplained pain: a retrospective cohort study using the United Kingdom General Practice Research Database |
title_full_unstemmed |
Health care costs before and after diagnosis of depression in patients with unexplained pain: a retrospective cohort study using the United Kingdom General Practice Research Database |
title_sort |
health care costs before and after diagnosis of depression in patients with unexplained pain: a retrospective cohort study using the united kingdom general practice research database |
publisher |
Dove Medical Press |
series |
ClinicoEconomics and Outcomes Research |
issn |
1178-6981 |
publishDate |
2013-01-01 |
description |
Catherine Reed,1 Jihyung Hong,2 Diego Novick,1 Alan Lenox-Smith,3 Michael Happich41Global Health Outcomes, Eli Lilly and Company, Windlesham, Surrey, UK; 2Personal Social Services Research Unit, London School of Economics and Political Science, London, UK; 3Eli Lilly UK, Basingstoke, UK; 4Eli Lilly and Company, Bad Homburg, GermanyPurpose: To assess the impact of pain severity and time to diagnosis of depression on health care costs for primary care patients with pre-existing unexplained pain symptoms who subsequently received a diagnosis of depression.Patients and methods: This retrospective cohort study analyzed 4000 adults with unexplained pain (defined as painful physical symptoms [PPS] without any probable organic cause) and a subsequent diagnosis of depression, identified from the UK General Practice Research Database using diagnostic codes. Patients were categorized into four groups based on pain severity (milder or more severe; based on number of pain-relief medications and use of opioids) and time to diagnosis of depression (≤1 year or >1 year from PPS index date). Annual health care costs were calculated (2009 values) and included general practitioner (GP) consultations, secondary care referrals, and prescriptions for pain-relief medications for the 12 months before depression diagnosis and in the subsequent 2 years. Multivariate models of cost included time period as a main independent variable, and adjusted for age, gender, and comorbidities.Results: Total annual health care costs before and after depression diagnosis for the four patient groups were higher for the groups with more severe pain (£819–£988 versus £565–£628; P < 0.001 for all pairwise comparisons) and highest for the group with more severe pain and longer time to depression diagnosis in the subsequent 2 years (P < 0.05). Total GP costs were highest in the group with more severe pain and longer time to depression diagnosis both before and after depression diagnosis (P < 0.05). In the second year following depression diagnosis, this group also had the highest secondary care referral costs (P < 0.01). The highest drug costs were in the groups with more severe pain (P < 0.001), although costs within each group were similar before and after depression diagnosis.Conclusion: Among patients with unexplained pain symptoms, significant pain in combination with longer time from pain symptoms to depression diagnosis contribute to higher costs for the UK health care system.Keywords: depression, pain, cost, GPRD, UK |
url |
http://www.dovepress.com/health-care-costs-before-and-after-diagnosis-of-depression-in-patients-a11944 |
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