Abstract
BackgroundPost-traumatic stress disorder is likely to affect clinical courses in the somatic hospital ward when appearing as comorbidity. Thus, this study aimed to assess the costs associated with comorbid post-traumatic stress disorder in a somatic hospital and to analyze if reimbursement appropriately compensated additional costs.MethodsThe study used data from a German university hospital between 2011 and 2014, analyzing 198,819 inpatient episodes. Inpatient’s episodes were included for analysis if they had a somatic primary diagnosis and a secondary diagnosis of post-traumatic stress disorder. Costs were calculated based on resource use and compared to reimbursement. Analyses were adjusted for sex, age and somatic comorbidities.ResultsN = 219 Inpatient’s episode were found with primary somatic disorder and a comorbid post-traumatic stress disorder. Inpatients episodes with comorbid post-traumatic stress disorder were compared to 34,229 control episodes, which were hospitalized with the same main diagnosis. Post-traumatic stress disorder was associated with additional hospital costs of €2311 [95%CI €1268 - €3355], while reimbursement rose by €1387 [€563 - €2212]. Results indicate that extra costs associated with post-traumatic stress disorder are not fully reimbursed. Male patients showed higher hospital costs associated with post-traumatic stress disorder. On average, post-traumatic stress disorder was associated with an extra length of stay of 3.4 days [2.1–4.6 days].ConclusionCosts associated with post-traumatic stress disorder were substantial and exceeded reimbursement, indicating an inadequate reimbursement for somatic patients with comorbid post-traumatic stress disorder.
Highlights
Post-traumatic stress disorder (PTSD) is diagnosed in individuals who were exposed to a traumatic event or who witnessed a traumatic event, when the following symptoms are observable: high physical arousal, negative thoughts leading to avoidance of trauma-related stimuli, and intrusive symptoms such as flashbacks or nightmares [DSM-V]
Only non-PTSD control episodes which were hospitalized with the same main diagnosis as PTSD inpatient episodes were considered for the analysis
As no official checklist for Cost of illness studies (COIs) exits, results reported in this study follow the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) where applicable [30]
Summary
Post-traumatic stress disorder (PTSD) is diagnosed in individuals who were exposed to a traumatic event or who witnessed a traumatic event, when the following symptoms are observable: high physical arousal, negative thoughts leading to avoidance of trauma-related stimuli, and intrusive symptoms such as flashbacks or nightmares [DSM-V]. In patients with back pain undergoing disc surgery, the presence of a comorbid psychiatric disorders predicted higher direct and indirect health care costs. In a retrospective study assessing the associated costs of psychiatric comorbidities additional costs of 1344€ were found [8]. In a study assessing the associated extra costs of mental disorders in an internal and psychosomatic department, reaction to severe stress, and adjustment disorders were found to have associated costs of 191€ per inpatient [9]. Post-traumatic stress disorder is likely to affect clinical courses in the somatic hospital ward when appearing as comorbidity. This study aimed to assess the costs associated with comorbid post-traumatic stress disorder in a somatic hospital and to analyze if reimbursement appropriately compensated additional costs
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