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BioPsychoSocial Medicine

, 9:11

First Online: 17 April 2015Received: 02 December 2014Accepted: 10 April 2015


BackgroundTo systematically review in- and outpatient costs in patients with coronary artery disease CAD and comorbid mental disorders.

MethodsA 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.

ResultsThe 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.

ConclusionsComorbid 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.

KeywordsCoronary artery disease Mental disorder Depression Comorbidity Health care costs Systematic review  Download fulltext PDF

Autor: Harald Baumeister - Anne Haschke - Marie Munzinger - Nico Hutter - Phillip J Tully


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