Comorbidities and Associated Treatment Charges in Patients with Anxiety Disorders

Trent McLaughlin, Ph.D., Erika C. Geissler, R.N., M.B.A., George J. Wan, Ph.D., M.P.H.


Pharmacotherapy. 2003;23(10) 

In This Article

Abstract and Introduction

Objective: To describe comorbidities and treatment charges in patients receiving initial anxiolytic therapy for anxiety disorders.
Design: Retrospective data analysis.
Patients: Six thousand six hundred forty-seven patients with anxiety disorders.
Measurements and Main Results: Analysis was conducted using medical and pharmacy data for patients in 26 United States health plans from the PharMetrics Integrated Outcomes database. Data were collected for 12 months before and after the first anxiolytic prescription date (index date) during the study period (January 1, 1998-December 31, 2000). The sample comprised patients with a diagnosis of anxiety disorder whose original anxiolytic prescription had been refilled within 120 days. International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) codes and medical and prescription data identified the existence of comorbidities, and medical and prescription charges. The most common diagnoses of anxiety disorder were anxiety not otherwise specified (67%), panic disorder (14%), and generalized anxiety disorder (13%). The most commonly prescribed anxiolytics were benzodiazepines, such as alprazolam (43%) and lorazepam (27%). Hypertension was the most common nonpsychiatric comorbidity (22%) and depression the most common psychiatric comorbidity (37%). Other comorbidities observed were lipid disorders (17%), chronic obstructive pulmonary disease (9%), and asthma (7%). Total treatment charges 12 months before and after initial anxiety diagnosis and anxiolytic prescription were $6279 and $9270, respectively (p<0.0001).
Conclusion: Chronic conditions are commonly associated with anxiety disorders. Recognizing these psychiatric and nonpsychiatric comorbidities is important when treating patients with these disorders. Treatment charges are significantly higher when a patient is diagnosed with an anxiety disorder, highlighting the impact of anxiety on the total cost of treatment for these patients.

Approximately 25% of the United States population will experience an anxiety disorder in their lifetime.[1] A study of the 1996 Medical Expenditure Panel Survey estimated that mood disorders, such as anxiety, were second only to hypertension in terms of prevalence and coronary heart disease regarding direct medical costs.[2] Anxiety disorders account for approximately one third of the total (direct plus indirect) economic costs of psychiatric disorders, amounting to over $46 billion annually.[3] The diagnosis of anxiety disorders has increased in recent years, and women account for an increasing proportion of all patients with anxiety.[4]

Patients with these disorders, such as generalized anxiety, social anxiety, and panic disorders, often consult a primary care physician for fluctuating levels of worry associated with insomnia, muscle tension, fatigue, irritability, and poor concentration.[5] Unrecognized and untreated anxiety disorders are associated with an unusually high rate of both psychiatric (especially depression) and medical (nonpsychiatric) comorbidity as well as medical resource use.[5] Patients with anxiety disorder use not only more primary care services, but emergency and hospital services as well.[6,7,8] This increased use of potentially expensive services places a substantial burden on the health care system.[9,10,11]

Our objective was to describe comorbidities and associated treatment charges in patients receiving initial anxiolytic therapy for anxiety disorders.


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