title: Inpatient and outpatient costs in patients with coronary artery disease and mental disorders: a systematic review.
abstract: BACKGROUND
  To systematically review in- and outpatient costs in patients with coronary artery disease (CAD) and comorbid mental disorders.
  
  
  METHODS
  A comprehensive database search was conducted for studies investigating persons with CAD and comorbid mental disorders (Medline, EMBASE, PsycINFO, Psyndex, EconLit, IBSS). All studies were included which allowed a comparison of in- and outpatient health care costs (assessed either monetarily or in terms of health care utilization) of CAD patients with comorbid mental disorders (mood, anxiety, alcohol, eating, somatoform and personality disorders) and those without. Random effects meta-analyses were conducted and results reported using forest plots.
  
  
  RESULTS
  The literature search resulted in 7,275 potentially relevant studies, of which 52 met inclusion criteria. Hospital readmission rates were increased in CAD patients with any mental disorder (pooled standardized mean difference (SMD) = 0.34 [0.17;0.51]). Results for depression, anxiety and posttraumatic stress disorder pointed in the same direction with heterogeneous SMDs on a primary study level ranging from -0.44 to 1.26. Length of hospital stay was not increased in anxiety and any mental disorder, while studies on depression reported heterogeneous SMDs ranging from -0.08 to 0.82. Most studies reported increased overall and outpatient costs for patients with comorbid mental disorders. Results for invasive procedures were non-significant respectively inconclusive.
  
  
  CONCLUSIONS
  Comorbid mental disorders in CAD patients are associated with an increased healthcare utilization in terms of higher hospital readmission rates and increased overall and outpatient health care costs. From a health care point of view, it is requisite to improve the diagnosis and treatment of comorbid mental disorders in patients with CAD to minimize incremental costs.
authors.affiliation: Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr 41, D-79085 Freiburg, Germany ; Medical Psychology and Medical Sociology, Medical Faculty, University of Freiburg, Freiburg, Germany.
authors.forename: Harald
authors.initials: H
authors.lastname: Baumeister
authors.affiliation: Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr 41, D-79085 Freiburg, Germany.
authors.forename: Anne
authors.initials: A
authors.lastname: Haschke
authors.affiliation: Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr 41, D-79085 Freiburg, Germany.
authors.forename: Marie
authors.initials: M
authors.lastname: Munzinger
authors.affiliation: Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr 41, D-79085 Freiburg, Germany.
authors.forename: Nico
authors.initials: N
authors.lastname: Hutter
authors.affiliation: Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr 41, D-79085 Freiburg, Germany ; Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, The University of Adelaide, Adelaide, Australia.
authors.forename: Phillip J
authors.initials: PJ
authors.lastname: Tully
keywords: Comorbidity; Coronary artery disease; Depression; Health care costs; Mental disorder; Systematic review