title: [Impact of morbidity, resource use and costs on maintenance of remission of major depression in Spain: a longitudinal study in a population setting].
abstract: 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 > or = 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.
  
  
  METHODS
  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 euro706.0 per patient in remission vs. euro1,108.3 without remission (p <0.001) and lost productivity was euro1,631.5 vs. euro2,024.2, respectively (p <0.001).
  
  
  CONCLUSIONS
  Patients not achieving remission showed higher morbidity, resources use, healthcare costs and, especially, productivity losses.
authors: Dirección de Planificación, Badalona Serveis Assistencials S.A., Badalona, Barcelona, España. asicras@bsa.cat
authors: Antoni
authors: A
authors: Sicras-Mainar
authors: Milagrosa
authors: M
authors: Blanca-Tamayo
authors: Laura
authors: L
authors: Gutiérrez-Nicuesa
authors: Jordi
authors: J
authors: Salvatella-Pasant
authors: Ruth
authors: R
authors: Navarro-Artieda
mesh_terms: D000041:Absenteeism; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000928:Antidepressive Agents / Q000191:economics / Q000627:therapeutic use; D015897:Comorbidity; D003219:Confidentiality; D017281:Cost of Illness; D003865:Major Depressive Disorder / Q000191:economics / Q000453:epidemiology*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D011306:Prescription Fees / Q000706:statistics & numerical data; D011446:Prospective Studies; D013030:Spain / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents