Psychiatric comorbidity in cardiovascular inpatients: Costs, net gain, and length of hospitalization

Hochlehnert, Achim; Niehoff, Dorothea; Wild, Beate; Jünger, Jana; Herzog, Wolfgang; Löwe, Bernd

doi:10.1016/j.jpsychores.2010.09.010

« Previous Next »Journal of Psychosomatic Research
Volume 70, Issue 2 , Pages 135-139, February 2011

Psychiatric comorbidity in cardiovascular inpatients: Costs, net gain, and length of hospitalization

Achim Hochlehnert
- Department of Psychosomatic and Internal Medicine II, University of Heidelberg, Heidelberg, Germany
- Corresponding author. Department of Internal Medicine II, University Hospital, University of Heidelberg, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany. Tel.: +49 6221 56 38654; fax: +49 6221 56 5749.
Dorothea Niehoff
- Department of Psychosomatic and Internal Medicine II, University of Heidelberg, Heidelberg, Germany
Beate Wild
- Department of Psychosomatic and Internal Medicine II, University of Heidelberg, Heidelberg, Germany
Jana Jünger
- Department of Psychosomatic and Internal Medicine II, University of Heidelberg, Heidelberg, Germany
Wolfgang Herzog
- Department of Psychosomatic and Internal Medicine II, University of Heidelberg, Heidelberg, Germany
Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf and Schön Klinik Hamburg Eilbek, Hamburg, Germany

Received 22 January 2010; received in revised form 14 September 2010; accepted 28 September 2010. published online 19 November 2010.

Abstract

Objective

Although psychiatric comorbidity often goes undetected and untreated in cardiovascular patients, it is not clear whether the costs for a special treatment of psychiatric comorbidity are appropriately reflected in the reimbursement system. To investigate the economic impact of psychiatric comorbidity, we compared costs, returns, net gain, and duration of hospitalization in cardiovascular inpatients with and without psychiatric comorbidity.

Methods

For a period of 2 years, we analyzed costs, net gain, and other outcome variables according to the diagnosis-related group (DRG) system for cardiovascular inpatients of a German university department (n=940). Psychiatric disorders were diagnosed by the treating physicians based on clinical criteria and results from the Patient Health Questionnaire (PHQ). With respect to the outcome variables, we compared patients with and without a psychiatric disorder, controlling for sociodemographic characteristics.

Results

The average total costs of hospitalization (mean±S.E.) for cardiovascular patients without psychiatric comorbidity and for patients with psychiatric comorbidity differed significantly (€5142±210 vs. €7663±571; d=0.39). The increased costs for patients with psychiatric comorbidity were related to elevated returns, but the net gain for patients without psychiatric comorbidity was €277±119. In contrast, the treatment of internal medicine patients with psychiatric disorders resulted in a net loss of −€624±324 (overall group difference, d=−0.25).

Conclusion

Psychiatric comorbidity in cardiovascular inpatients leads to higher costs that are not reflected in the current reimbursement system in Germany. The inappropriate reimbursement of psychiatric comorbidity in cardiovascular inpatients may result in a serious undertreatment of these patients.

Keywords: Diagnosis-related groups (DRG), Health care costs, Inpatients, Internal medicine, Mental disorders