Multimorbidity and Its Associations With Anxiety and Depression Among Newly Diagnosed Patients With Breast Cancer: A Retrospective Observational Cohort Study in a US Commercially Insured and Medicare Advantage Population

Dai, Dingwei; Coetzer, Henriette; Zion, Sean R.; Malecki, Michael

doi:10.1177/10732748221140691

Cited by 5 publications

(13 citation statements)

References 52 publications

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“…Moreover, multiple comorbidities are common among patients with breast cancer and are associated with increased risk of anxiety and depression in the first year following breast cancer diagnosis. 19 Due to limited availability of specialized psychological care for patients with cancer, 17,18 there is a growing need for new treatment modalities, such as digital therapeutics. A recent review suggests that digital therapeutics in oncology possess clinical value, provide benefits perceived by both patients and healthcare providers, and may have a positive impact on HCRU, although further research is needed.…”

Section: Discussionmentioning

confidence: 99%

“…Details of the study design and data source have been published previously. 19 Detailed inclusion and exclusion criteria are described in Supplementary Figure S1. The database includes over 20 million Aetna members and contains patient-level data including inpatient and outpatient data, and medical and pharmacy claims of fully insured commercial health plan and Medicare Advantage members.…”

Section: Methodsmentioning

confidence: 99%

“…Breast cancer was defined as (1) 1 hospitalization with case-defining breast cancer (ICD-10-CM: C50.x) in the first diagnostic position (primary diagnosis), or (2) 1 hospitalization with a Z code indicating radiotherapy (Z51.12) in the first diagnostic position and any case-defining diagnosis of breast cancer (C50.x) in the second diagnostic position, or (3) 3 or more outpatient medical encounters occurring within a 90-day period with any case-defining diagnoses of breast cancer (C50.x) in the first or second diagnostic position. 19 The demographic characteristics of patients included age at index date; US geographic region (Midwest, Northeast, South, and West); rural, suburban, or urban residence; and median household income. Household income was estimated by merging 2010 US Census data with the claims data using zip codes.…”

Section: Methodsmentioning

confidence: 99%

“…During the first year following breast cancer diagnosis, patients with anxiety, depression, or stress reaction/adjustment reaction incurred significantly higher average costs for ED visits ($1146 [2806] vs $598 [1936] per patient per year [PPPY]; P < .0001), inpatient admissions ($8394 [23 123] vs $4496 [15 671] PPPY; P < .0001), PCP visits ($1082 [4398] vs $794 [6561] PPPY; P < .0001), and specialist visits ($8738 [23 938] vs $6846 [21 963] PPPY; P < .0001) compared with patients without these psychiatric disorders. On average, total medical costs ($65 594 [90 999] vs $52 212 [78 397] PPPY; P < .0001), total pharmacy costs ($6628 [25 091] vs $5199 [19,797] PPPY; P < .0001), and total healthcare costs ($72 223 [94 646] vs $57 411 [81 088] PPPY; P < .0001) were significantly higher for patients with anxiety, depression, or stress reaction/adjustment disorder than patients without these psychiatric disorders (Table 2).…”

Section: Index Datementioning

confidence: 99%

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Anxiety, Depression, and Stress Reaction/Adjustment Disorders and Their Associations with Healthcare Resource Utilization and Costs Among Newly Diagnosed Patients With Breast Cancer

Dai

Coetzer

Zion³

et al. 2023

Journal of Health Economics and Outcomes Research

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Background: Breast cancer is the most common cancer among women in the United States. Newly diagnosed patients with breast cancer often experience anxiety, depression, and stress. However, the impact of psychological distress on healthcare resource utilization (HCRU) and costs has not been adequately assessed. Objectives: To evaluate the incidence and prevalence of anxiety, depression, and stress reaction/adjustment disorder among patients newly diagnosed with breast cancer, to examine HCRU and costs, and to assess the association of these psychiatric disorders with costs. Methods: This retrospective observational cohort study was conducted using a large US administrative claims database with an index date of newly diagnosed breast cancer. Demographics and comorbidities (including anxiety, depression, and stress reaction/adjustment disorder) were assessed using data collected 12 months before and after the index date. HCRU and costs were assessed using data collected 12 months after the index date. Generalized linear regressions were performed to examine the association between healthcare costs and anxiety, depression, and stress reaction/adjustment disorder. Results: Of 6392 patients with newly diagnosed breast cancer, 38.2% were diagnosed with psychiatric disorders including anxiety (27.7%), depression (21.9%), or stress reaction/adjustment disorder (6%). The incidence of these psychiatric disorders was 15% and the prevalence was 23.2%. Patients with anxiety, depression, or stress reaction/adjustment disorder had higher rates of several types of HCRU (P < .0001) and higher total all-cause costs compared with patients without these psychiatric disorders (P < .0001). Patients with incident anxiety, depression, or stress reaction/adjustment disorder incurred higher all-cause costs in the first year following breast cancer diagnosis than those with prevalent anxiety, depression, or stress reaction/adjustment disorder (P < .0003), or those without these psychiatric disorders (P < .0001). Discussion: Of patients with anxiety, depression, or stress reaction/adjustment disorder, those with incident psychiatric disorders had higher healthcare costs, suggesting that new-onset psychological distress may contribute to higher costs incurred by the payer. Timely treatment of psychiatric disorders in this population may improve clinical outcomes and reduce HCRU and costs. Conclusions: Anxiety, depression, and stress reaction/adjustment disorder were common among patients newly diagnosed with breast cancer and were associated with increased healthcare costs in the first year following breast cancer diagnosis.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Index Datementioning

confidence: 99%

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Anxiety, Depression, and Stress Reaction/Adjustment Disorders and Their Associations with Healthcare Resource Utilization and Costs Among Newly Diagnosed Patients With Breast Cancer

Dai

Coetzer

Zion³

et al. 2023

Journal of Health Economics and Outcomes Research

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“…The 42 most common chronic conditions in the Aetna claims data were included and identified using previously described methods based on ICD-10-CM codes. 8,15 The list of each chronic condition, its acronym or abbreviation, and the corresponding ICD-10-CM codes used in this study are reported in Supplementary Table S1. We included 18 of the 20 comorbid conditions recommended by the US Department of Health and Human Services for studying multimorbidity because they are chronic, prevalent, and potentially amenable to intervention.…”

Section: Assessment Of Comorbidity and Multimorbiditymentioning

confidence: 99%

Multimorbidity in Atherosclerotic Cardiovascular Disease and Its Associations With Adverse Cardiovascular Events and Healthcare Costs: A Real-World Evidence Study

Dai,

Fernandes,

Sun

et al. 2024

Journal of Health Economics and Outcomes Research

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Background: Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of mortality and disability in the United States and worldwide. Objective: To assess the multimorbidity burden and its associations with adverse cardiovascular events (ACE) and healthcare costs among patients with ASCVD. Methods: This is a retrospective observational cohort study using Aetna claims database. Patients with ASCVD were identified during the study period (1/1/2018–10/31/2021). The earliest ASCVD diagnosis date was identified as the index date. Qualified patients were ≥18 years of age and had ≥12 months of health plan enrollment before and after the index date. Comorbid conditions were assessed using all data available within 12 months prior to and including the index date. Association rule mining was applied to identify comorbid condition combinations. ACEs and healthcare costs were assessed using all data within 12 months after the index date. Multivariable generalized linear models were performed to examine the associations between multimorbidity and ACEs and healthcare costs. Results: Of 223 923 patients with ASCVD (mean [SD] age, 73.6 [10.7] years; 42.2% female), 98.5% had ≥2, and 80.2% had ≥5 comorbid conditions. The most common comorbid condition dyad was hypertension-hyperlipidemia (78.7%). The most common triad was hypertension–hyperlipidemia–pain disorders (61.1%). The most common quartet was hypertension–hyperlipidemia–pain disorders–diabetes (30.2%). The most common quintet was hypertension–hyperlipidemia–pain disorders–diabetes–obesity (16%). The most common sextet was hypertension–hyperlipidemia–pain disorders–diabetes–obesity–osteoarthritis (7.6%). The mean [SD] number of comorbid conditions was 7.1 [3.2]. The multimorbidity burden tended to increase in older age groups and was comparatively higher in females and in those with higher social vulnerability. The increased number of comorbid conditions was significantly associated with increased ACEs and increased healthcare costs. Discussion: Extremely prevalent multimorbidity should be considered in the context of clinical decision-making to optimize secondary prevention of ASCVD. Conclusions: Multimorbidity was extremely prevalent among patients with ASCVD. Multimorbidity patterns varied considerably across ASCVD patients and by age, gender, and social vulnerability status. Multimorbidity was strongly associated with ACEs and healthcare costs.

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Szorongás, depresszió, valamint fizikai tüneti terhek felmérése és összefüggéseik megismerése daganatos betegek körében

Varga,

Horváth,

Busa

et al. 2024

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Bevezetés: A daganatos megbetegedésekre jellemzőek a megnövekedett pszichés terhek. A jelentős fizikai tüneti terhek, a multimorbiditás, a szorongás és a depresszió kialakulásának kockázati tényezői lehetnek daganatos betegekben, mely összefüggések vizsgálatára tudomásunk szerint eddig még nem került sor Magyarországon. Célkitűzés: Célunk volt (1) felmérni a szorongás és (2) a depresszió szintjét daganatos betegek körében, (3) megvizsgálni, hogy milyen fizikai tüneti terhek jelennek meg leginkább az onkológiai betegek között, (4) megismerni a szorongás, a depresszió és a fizikai tüneti terhek és (5) a multimorbiditás összefüggéseit. Módszer: Keresztmetszeti vizsgálatunkba 18. életévüket betöltött, daganatos megbetegedés diagnózisával rendelkező betegeket vontunk be. A kvantitatív adatok feldolgozása során az eredményeket 0,05 alatti p-érték esetén tekintettük szignifikánsnak. Eredmények: A vizsgálatban 113 beteg vett részt. A válaszadók 29,2%-ában a normális határértéknél magasabb szintű szorongást mértünk, a depresszió pedig 36,2%-ban volt jelen különböző súlyosságban. Alvási nehézségekről a megkérdezettek 69,5%-a, fáradtságról 66,3%, fájdalomról 52,2% számolt be. A normálérték feletti szorongást és depressziót mutatók átlagosan több fizikai tüneti terhet említettek. Szignifikáns összefüggés volt kimutatható a normálérték feletti depressziót mutatók és a fáradtság, valamint a fájdalom között. A multimorbiditást tekintve a normálérték feletti szorongást mutatók átlagosan több krónikus betegséggel rendelkeztek. Megbeszélés: Vizsgálatunkban a szorongás szintje magasabb, a depresszió szintje azonban egyezik a nemzetközi adatokkal. Az alvási nehézségek nagyobb arányban fordulnak elő vizsgálatunkban, a fáradtság és a fájdalom előfordulása azonban összhangban áll a nemzetközi kutatások eredményeivel. Az eddig publikált nemzetközi vizsgálatokhoz hasonlóan vizsgálatunk is a multimorbiditás, a megnövekedett fizikai tüneti terhek, továbbá a szorongás és a depresszió közötti jelentős összefüggésre utal. Következtetés: A szorongás és a depresszió nagy arányban van jelen onkológiai betegekben. A legnagyobb arányban az alvási nehézségek fordulnak elő, ezt követi a fáradtság és a fájdalom. A szorongás és depresszió mértéke összefüggést mutat a fizikai tüneti terhekkel, valamint a multimorbiditás is fokozza a betegek szorongásszintjét. Orv Hetil. 2024; 165(8): 309–317.

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Multimorbidity and Its Associations With Anxiety and Depression Among Newly Diagnosed Patients With Breast Cancer: A Retrospective Observational Cohort Study in a US Commercially Insured and Medicare Advantage Population

Cited by 5 publications

References 52 publications

Anxiety, Depression, and Stress Reaction/Adjustment Disorders and Their Associations with Healthcare Resource Utilization and Costs Among Newly Diagnosed Patients With Breast Cancer

Anxiety, Depression, and Stress Reaction/Adjustment Disorders and Their Associations with Healthcare Resource Utilization and Costs Among Newly Diagnosed Patients With Breast Cancer

Multimorbidity in Atherosclerotic Cardiovascular Disease and Its Associations With Adverse Cardiovascular Events and Healthcare Costs: A Real-World Evidence Study

Szorongás, depresszió, valamint fizikai tüneti terhek felmérése és összefüggéseik megismerése daganatos betegek körében

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