title: Health care costs in persons with asthma and comorbid mental disorders: a systematic review.
abstract: OBJECTIVE
  The aim of this study was to systematically review the impact of comorbid mental disorders on health care costs in adult persons with asthma.
  
  
  METHODS
  A comprehensive search for studies investigating adult persons (≥18 years) with asthma was conducted. All studies were included, which allowed a comparison of health care utilization and costs between asthma patients with mental disorders and asthma patients without.
  
  
  RESULTS
  The literature search revealed 1977 potentially relevant studies. Eighteen primary studies (20 publications) fulfilled the inclusion criteria. Mood disorders (n=14) and anxiety disorders (n=9) were studied most often. Increased rates of hospitalizations (odds ratio range, 0.9-6.1; n=7), emergency department visits (odds ratio range, 1.8-17.2; n=7) and general practitioner visits (standardized mean difference range, 0.1-1.1; n=6) were found in asthma patients with mental comorbidity. Indirect costs of work absence were investigated in two studies pointing in the same direction of increased costs. Evidence is sparse regarding other outcomes due to a lack of primary studies.
  
  
  CONCLUSIONS
  The present systematic review highlights a meaningful impact of comorbid mental disorders on health care utilization and costs in adult patients with asthma. Thus, psychodiagnostic routines and appropriate mental health treatments are needed to reduce health care costs in asthma care.
authors.affiliation: Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Germany. nico.hutter@psychologie.uni-freiburg.de
authors.forename: Nico
authors.initials: N
authors.lastname: Hutter
authors.forename: Annika
authors.initials: A
authors.lastname: Knecht
authors.forename: Harald
authors.initials: H
authors.lastname: Baumeister
mesh_terms: D001249:Asthma / Q000150:complications / Q000191:economics / Q000523:psychology / Q000628:therapy; D015897:Comorbidity; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data; D017048:Health Care Costs / Q000706:statistics & numerical data; D006268:Health Facilities / Q000191:economics* / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D001523:Mental Disorders / Q000150:complications / Q000191:economics / Q000628:therapy; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data