February 22, 2018Rheumatology and TherapyOpen Access

Cost of Depression in Japanese Patients with Rheumatoid Arthritis: Evidence from Administrative Data

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Rheumatoid arthritis (n=8968). Intervention: Depression comorbidity vs. Rheumatoid arthritis without depression. Primary outcome: Total outpatient visits at 6 months (HR 1.45, 95% CI 1.305-1.610, p=<0.0001).

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Key result

Depression comorbidity in Japanese patients with rheumatoid arthritis was associated with a significantly higher risk of total outpatient visits (HR 1.45) and emergency room visits (HR 2.06) at 6 months.

Why the study?

Does depression comorbidity increase healthcare utilization and costs in Japanese patients with rheumatoid arthritis?

Study Design

Type

Cohort (n=8,968)

Structured PICO

Does depression comorbidity increase healthcare utilization and costs in Japanese patients with rheumatoid arthritis?

Population

8,968 Japanese adults with rheumatoid arthritis, of whom 5% had comorbid depression, followed for up to 12 months to assess healthcare utilization and costs.

Exposure

Comorbidity of depression (defined by at least two ICD-10 diagnoses and at least two prescriptions for antidepressants)

Comparator

RA patients without depression comorbidity (propensity score matched)

Outcome

Health care utilization characteristics (outpatient visits, emergency room visits, hospitalizations) and direct costs/expenditures at 6 and 12 months

Main Result

Hazard Ratio: 1.45 (95% CI 1.305–1.61)

Absolute Event Rate: 3.073% vs 1.899%

p-value: p=<0.0001

Depression comorbidity in Japanese patients with rheumatoid arthritis is associated with significantly higher healthcare utilization and medical costs.

Limitations

Inability to identify clinical parameters and disease severity from the claims database
Potential coding quality issues where disease codes may not reflect clinical reality
Bias towards patients employed at private Japanese companies, potentially excluding those with severe disease unable to work
Could not identify clinical parameters and disease severity from the claims database
Coding quality issues inherent to claims databases
Bias towards patients employed at private Japanese companies, potentially underestimating actual prevalence

Implication

May prompt depression screening in RA to anticipate higher utilization; leaves open whether treatment reduces visits.

Abstract

INTRODUCTION: To determine the cost of depression comorbidity among Japanese adults with rheumatoid arthritis (RA). METHODS: A retrospective database study of 8968 patients diagnosed with RA between 2010 and 2015 and treated with any RA medication was conducted. Health care utilization characteristics were compared between patients with and without a comorbidity of depression. Propensity score matching was applied to ensure a balanced comparison between the two cohorts. RESULTS: The prevalence of a depression comorbidity was found for 5% of the total RA patients. This comorbidity was associated with 62% (56%) higher total outpatient visits and 66% (163%) higher rate of emergency room visits after 6 (12) months. CONCLUSIONS: Burden of depression among RA patients in Japan is relatively high and awareness for depression as a comorbidity of RA needs to be reinforced. FUNDING: Janssen Pharmaceutical KK.

Discussion

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Cite This Study

Guelfucci et al. (2018) conducted a cohort in Rheumatoid arthritis (n=8,968). Depression comorbidity vs. Rheumatoid arthritis without depression was evaluated on Total outpatient visits at 6 months (HR 1.45, 95% CI 1.305-1.610, p=<0.0001). Depression comorbidity in Japanese patients with rheumatoid arthritis was associated with a significantly higher risk of total outpatient visits (HR 1.45) and emergency room visits (HR 2.06) at 6 months.

synapsesocial.com/papers/6a74743c96d04a2f43f53f07 https://doi.org/10.1007/s40744-018-0096-4

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Implication

May prompt depression screening in RA to anticipate higher utilization; leaves open whether treatment reduces visits.

Cost of Depression in Japanese Patients with Rheumatoid Arthritis: Evidence from Administrative Data

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Cost of Depression in Japanese Patients with Rheumatoid Arthritis: Evidence from Administrative Data

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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