title: Clinical and economic burden of depression/anxiety in chronic obstructive pulmonary disease patients within a managed care population.
abstract: BACKGROUND
  Anxiety and depression are common co-morbidities that can complicate the course of chronic obstructive pulmonary disease (COPD). The purpose of this study was to evaluate their impact on healthcare utilization and costs in a managed care COPD population.
  
  
  METHODS
  Administrative claims data were used to conduct a retrospective cohort study of COPD patients ≥ 40 years of age, including those with co-morbid COPD-Depression (including anxiety). COPD-Depression patients were matched to COPD patients without depression (COPD-Only cohort) using propensity scores. Conditional logistic regression models assessed the 1-year risk of COPD exacerbations (i.e., emergency room [ER] visit/inpatient hospitalization) between cohorts. Differences in annual all-cause and COPD-related utilization/costs, along with 2-year costs, were also compared between the cohorts.
  
  
  RESULTS
  There were 3,761 patients per cohort. Patients in the COPD-Depression cohort were 77% more likely to have a COPD-related hospitalization (odds ratio [OR] = 1.77, P < 0.001), 48% more likely to have an ER visit (OR = 1.48, P < 0.001), and 60% more likely to have hospitalization/ER visit (OR = 1.60, P < 0.001) compared to the COPD-Only cohort. Average annual all-cause medical cost per patient was $23,759 for COPD-Depression vs $17,765 for COPD-Only (P < 0.001) and total (medical plus pharmacy) cost was $28,961 vs $22,512 (P < 0.001), respectively; corresponding average annual COPD-related medical cost was $2,040 vs $1,392 (P < 0.001) and total cost was $3,185 vs $2,680 (P < 0.001). Similar trends were observed over the 2-year period.
  
  
  CONCLUSIONS
  In the COPD population, patients with depression/anxiety have significantly higher risk of COPD exacerbations and annual all-cause and COPD-related costs than patients without these co-morbidities. These findings may have therapeutic implications and seem worthy of further exploration.
authors.affiliation: GlaxoSmithKline, Research Triangle Park, North Carolina, USA. anand.a.dalal@gsk.com
authors.forename: Anand A
authors.initials: AA
authors.lastname: Dalal
authors.forename: Manan
authors.initials: M
authors.lastname: Shah
authors.forename: Orsolya
authors.initials: O
authors.lastname: Lunacsek
authors.forename: Nicola A
authors.initials: NA
authors.lastname: Hanania
mesh_terms: D000368:Aged; D014151:Anti-Anxiety Agents / Q000191:economics / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000191:economics / Q000627:therapeutic use; D001007:Anxiety / Q000188:drug therapy / Q000191:economics / Q000209:etiology / Q000523:psychology*; D001993:Bronchodilator Agents / Q000191:economics / Q000627:therapeutic use; D016009:Chi-Square Distribution; D003863:Depression / Q000188:drug therapy / Q000191:economics / Q000209:etiology / Q000523:psychology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008329:Managed Care Programs; D008875:Middle Aged; D057216:Propensity Score; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000188:drug therapy / Q000191:economics / Q000523:psychology*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents; D001993:Bronchodilator Agents