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. 2015 Apr 17:9:11.
doi: 10.1186/s13030-015-0039-z. eCollection 2015.

Inpatient and outpatient costs in patients with coronary artery disease and mental disorders: a systematic review

Harald Baumeister  1 , Anne Haschke  2 , Marie Munzinger  2 , Nico Hutter  2 , Phillip J Tully  3
Affiliations

Inpatient and outpatient costs in patients with coronary artery disease and mental disorders: a systematic review

Harald Baumeister et al. Biopsychosoc Med. .

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.

Keywords: Comorbidity; Coronary artery disease; Depression; Health care costs; Mental disorder; Systematic review.

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Figures

Figure 1
Figure 1
Selection process of primary studies.
Figure 2
Figure 2
Primary studies regarding hospital readmission rates.
Figure 3
Figure 3
Primary studies regarding catheterization rates.
Figure 4
Figure 4
Primary studies regarding rates for CABG.
Figure 5
Figure 5
Primary studies regarding rates for PTCA.
Figure 6
Figure 6
Primary studies regarding length of index hospital stay.
See this image and copyright information in PMC

References

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