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Meta-Analysis
. 2018 Mar 13;13(3):e0194029.
doi: 10.1371/journal.pone.0194029. eCollection 2018.

Health-economic outcomes in hospital patients with medical-psychiatric comorbidity: A systematic review and meta-analysis

Luc Jansen  1   2 , Maarten van Schijndel  1   3 , Jeroen van Waarde  3 , Jan van Busschbach  1
Affiliations
Meta-Analysis

Health-economic outcomes in hospital patients with medical-psychiatric comorbidity: A systematic review and meta-analysis

Luc Jansen et al. PLoS One. .

Abstract

Background: Hospital inpatients often experience medical and psychiatric problems simultaneously. Although this implies a certain relationship between healthcare utilization and costs, this relationship has never been systematically reviewed.

Objective: The objective is to examine the extent to which medical-psychiatric comorbidities relate to health-economic outcomes in general and in different subgroups. If the relationship is significant, this would give additional reasons to facilitate the search for targeted and effective treatments for this complex population.

Method: A systematic review in Embase, Medline, Psycinfo, Cochrane, Web of Science and Google Scholar was performed up to August 2016 and included cross-references from included studies. Only peer-reviewed empirical studies examining the impact of inpatient medical-psychiatric comorbidities on three health-economic outcomes (length of stay (LOS), medical costs and rehospitalizations) were included. Study design was not an exclusion criterion, there were no restrictions on publication dates and patients included had to be over 18 years. The examined populations consisted of inpatients with medical-psychiatric comorbidities and controls. The controls were inpatients without a comorbid medical or psychiatric disorder. Non-English studies were excluded.

Results: From electronic literature databases, 3165 extracted articles were scrutinized on the basis of title and abstract. This resulted in a full-text review of 86 articles: 52 unique studies were included. The review showed that the presence of medical-psychiatric comorbidity was related to increased LOS, higher medical costs and more rehospitalizations. The meta-analysis revealed that patients with comorbid depression had an increased mean LOS of 4.38 days compared to patients without comorbidity (95% CI: 3.07 to 5.68, I2 = 31%).

Conclusions: Medical-psychiatric comorbidity is related to increased LOS, medical costs and rehospitalization; this is also shown for specific subgroups. This study had some limitations; namely, that the studies were very heterogenetic and, in some cases, of poor quality in terms of risk of bias. Nevertheless, the findings remain valid and justify the search for targeted and effective interventions for this complex population.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Flowchart of study results.
Fig 2
Fig 2. Relation of medical-psychiatric comorbidity and length of stay (LOS) (because the study of Fulop et al. [1987] included two separate samples in two hospitals, both outcomes are included in the analyses).
Fig 3
Fig 3. Relationship between medical-psychiatric comorbidity and medical costs.
Fig 4
Fig 4. Meta-analysis in the subgroup depression examining the impact on length of stay (LOS).
See this image and copyright information in PMC

References

    1. Van Waarde J. A., et al. "De medisch-psychiatrische unit: meerwaarde voor patiënten, artsen en ziekenhuizen." Nederlands tijdschrift voor geneeskunde 1485 (2004): 209–211. - PubMed
    1. Kathol Roger, et al. "Epidemiologic trends and costs of fragmentation." Medical Clinics of North America 904 (2006): 549–572. doi: 10.1016/j.mcna.2006.04.002 - DOI - PubMed
    1. Abbate-Daga G., Delsedime N., Nicotra B., Giovannone C., Marzola E., Amianto F., et al. Psychosomatic syndromes and anorexia nervosa. BMC Psychiatry. 2013;13. - PMC - PubMed
    1. Doherty A. M., Gaughran F. The interface of physical and mental health. Social Psychiatry and Psychiatric Epidemiology. 2014;49(5):673–82. doi: 10.1007/s00127-014-0847-7 - DOI - PubMed
    1. Harris E. C., Barraclough B. Excess mortality of mental disorder. The British Journal of Psychiatry. 1998;173(1):11–53. - PubMed