title: Depression-related treatment and costs in Germany: Do they change with comorbidity? A claims data analysis.
abstract: BACKGROUND
  Existing diverse bottom-up estimations of direct costs associated with depression in Germany motivated a detailed patient-level analysis of depression-related treatment (DRT), -costs (DRC) and Comorbidity.
  
  
  METHODS
  A large sickness fund's claims data was used to retrospectively identify patients aged 18-65 years with new-onset depression treatment between January 1st and February 15th 2010, and follow them until December 31st 2010, describe DRT, estimate associated DRC, and predict DRC with a generalised linear model.
  
  
  RESULTS
  A total of 18,139 patients were analysed. Mean direct DRC were €783. Predictors of DRC regarding psychiatric comorbidities were: "Delusion, psychotic disorders and personality disorders" (DRC-ratio 1.72), "Alcohol/drug addiction" (1.82), "abuse of alcohol/drugs" (1.57). Predictors of DRC regarding medical comorbidities were: "Rheumatoid arthritis" (0.77), "atherosclerosis" (0.65), "pregnancy" (0.66), and "Osteoarthritis" (1.87). Of all patients, 60.8% received their most intense/specialised DRT from a general practitioner, a medical specialist (23.7%), a psychotherapist (8.0%), a medical specialist and psychotherapist (2.9%), or in hospital (4.6%). Serious psychiatric comorbidity nearly tripled depression-related hospitalisation rates.
  
  
  CONCLUSIONS
  Seasonal affective disorder and missing psychiatric outpatient clinic data must be considered.
  
  
  CONCLUSIONS
  Estimated DRC are significantly below the assessment of the German national guideline. Differing definitions of observation period and cost attribution might explain differing German DRC results. Signs of hospital psychiatric comorbidity bias indicate overestimation of hospital DRC. Identified associations of DRC with certain medical diseases in older adults warrant further research. Up to one quarter of patients with severe depression diagnosis might lack specialist treatment.
authors.affiliation: Institute for Health Economics and Clinical Epidemiology, Cologne University Hospital, Germany. Electronic address: wagnerc1@uni-koeln.de.
authors.forename: Christoph J
authors.initials: CJ
authors.lastname: Wagner
authors.affiliation: Department of Psychiatry and Psychotherapy and Geriatric Center, Tuebingen University Hospital, Germany.
authors.forename: Florian G
authors.initials: FG
authors.lastname: Metzger
authors.affiliation: BARMER GEK Statutory Health Insurance Fund, Headquarters, 42285 Wuppertal, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Sievers
authors.affiliation: BARMER GEK Statutory Health Insurance Fund, Headquarters, 42285 Wuppertal, Germany.
authors.forename: Ursula
authors.initials: U
authors.lastname: Marschall
authors.affiliation: BARMER GEK Statutory Health Insurance Fund, Headquarters, 42285 Wuppertal, Germany.
authors.forename: Helmut
authors.initials: H
authors.lastname: L'hoest
authors.affiliation: Institute of Health Economics and Health Care Management, Helmholtz Zentrum Muenchen, Germany.
authors.forename: Bjoern
authors.initials: B
authors.lastname: Stollenwerk
authors.affiliation: Institute for Health Economics and Clinical Epidemiology, Cologne University Hospital, Germany.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Stock
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015897:Comorbidity; D017281:Cost of Illness; D003863:Depression / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
keywords: Claims data; Comorbidity; Cost-of-illness; Depression; Depression-related treatment; Direct costs; Germany