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


Patient-level clinical and treatment charge data were captured from the PharMetrics Integrated Outcomes database, which contains adminis-trative claims data from over 30 managed care plans across the United States. This database also encompasses inpatient and outpatient medical care, prescription claims, and ancillary charges. Data from 26 plans were used for this analysis, representing approximately 10 million covered lives. The greatest representation of patients was in the South (45% of the sample) and Midwest (28%). Approximately 14% and 13% of the sample were from plans in the West and East, respectively.

The study population was identified from the database from January 1, 1998-December 31, 2000. Any patient in the PharMetrics database who met the criteria was considered eligible for inclusion; the criteria were receipt of the following:

  • An index prescription for an anxiolytic, such as a benzodiazepine (alprazolam, chlordia-zepoxide, clorazepate, diazepam, lorazepam, or oxazepam) or another anxiolytic (buspirone or meprobamate). Prescription date and index date were the same.

  • A second prescription claim of the index anxiolytic within 120 days after the index date.

  • A diagnosis of anxiety disorder within 30 days before to 6 months after the index prescription (to ensure that the drug was administered to treat anxiety). Anxiety was defined using codes of the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), as follows: 293.84 (anxiety disorder due to a general medical condition), 300.00 (anxiety disorder not otherwise specified), 300.01 (panic disorder without agoraphobia), 300.02 (generalized anxiety disorder), 300.21 (panic disorder with agoraphobia), 300.22 (agoraphobia without history of panic disorder), 300.23 (social phobia), 300.29 (specific phobia), 300.3 (obsessive-compulsive disorder), 308.3 (acute stress disorder), and 309.81 (posttraumatic stress disorder).

Patients who met any of the following criteria either before or after the index date were removed from the analysis: received an anxiolytic prescription during the 12 months before the index date; were diagnosed with anxiety disorder in the 12 months before the index date (excluding the 30 days immediately before receiving the index prescription); received a prescription for a lithium or an antipsychotic drug during the study period; were diagnosed with dementia, schizophrenia, a psychotic disorder or condition, affective psychosis, paranoid state, neurotic disorder, personality disorder, nonpsychotic mental disorder, mental retardation, or insomnia during the study period; were younger than 18 years on the index date; had not been continuously enrolled in their health plan for the 12 months before and 12 months after the index date; or lacked complete medical and pharmacy claims data (e.g., Medicare supplemental patients).

The following four cohorts were determined based on frequency of occurrence of the initial anxiety diagnosis: patients with generalized anxiety disorder, those with anxiety disorder not otherwise specified, those with panic disorder (with or without agoraphobia), and those with other anxiety disorders (anxiety disorder due to a general medical condition, agoraphobia without history of panic disorder, social phobia, specific phobia, obsessive-compulsive disorder, acute stress disorder, or posttraumatic stress disorder).

This study was a descriptive analysis of treatment patterns and comorbid illness in patients with documented diagnosis and treatment of anxiety. Descriptive metrics were the prevalence of other diagnoses in the sample, concomitant drug therapy, and patient demographics. Total resource use and treatment charge data were collected and analyzed to assess charges. All medical claims in the year after receipt of the initial anxiolytic prescription were assessed to establish annual resource use rates. Treatment charges (for inpatient, outpatient, emergency, ancillary, and pharmaceutical care) were reported as means ± SD (s). Given the relatively short study period, no attempt was made to standardize treatment charges across the years. Treatment charges before and after the index date were compared using paired t tests to determine statistical significance.

All categoric variables (e.g., sex, presence of comorbid conditions, and concomitant drug therapy) are reported as percentages and were compared using the test of proportions and independent samples. The level of significance for all tests was an a of 0.05. An average was obtained for the percentage of patients identified as having a comorbid condition 12 months before and after the date of the initial anxiolytic prescription claim. An average of the two time periods also was obtained for the percentage of patients identified as taking a concomitant drug.


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