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


Seventy-two percent of the study patients were women older than 40 years at the time of the initial anxiolytic prescription claim ( Table 1 ). Patients aged 40-49 years represented the largest age group, 31% of patients. The most common physician specialties associated with the anxiety diagnosis were general practice, family practice, and internal medicine; 61% of the study patients were cared for by one of these specialists. The most common anxiety diagnosis was anxiety disorder not otherwise specified, which accounted for 67% of the study sample. Panic disorder accounted for an additional 14%, generalized anxiety disorder for 13%, and other anxiety disorders the remainder.

As shown in Table 2 , alprazolam was the most commonly prescribed initial anxiolytic (43% of study patients). Compared with the other anxiety subtypes, patients with panic disorder (with or without agoraphobia) were more likely to receive alprazolam (52% vs 43% of patients with anxiety not otherwise specified, p<0.0001). Other commonly administered agents were lorazepam and buspirone (27% and 14%, respectively).

The most common comorbid conditions identified during the study period are presented in Table 3 . The most common chronic medical diagnosis (nonpsychiatric) was hypertension, which was identified in 22% of all patients, whereas depression (ICD-9-CM codes 296.2x, 296.3x, 300.4, 311) was the most common psychiatric comorbidity (37%). Lipid disorders were also common, being identified in 17% of the study patients, whereas chronic respiratory conditions such as chronic obstructive pulmonary disorder and asthma were present in 9% and 7% of study patients, respectively. Other cardiovascular and endocrine conditions, such as coronary heart disease and diabetes, were diagnosed in 7% and 6%, respectively.

Pain-related diagnoses were also common; 21% of all patients had at least one documented claim for chest pain, 18% had abdominal pain, and 14% had joint pain. Headache and dyspnea were also prevalent (11% each).

Use of concomitant drug therapy was frequent in all study patients before and after the initial anxiolytic prescription claim ( Table 3 ). Specifically, drugs associated with pain relief were common; 30% of patients had at least one prescription claim for a codeine-containing analgesic. Examples of other common concomitant therapies were selective serotonin reuptake inhibitors (36%), antiarthritic agents (28%), tricyclic antidepressants (24%), and minor tranquilizers (16%).

For the 12 months before the initial anxiety diagnosis and anxiolytic prescription, treatment charges were an average of $6279/patient ( Table 4 ). The largest cost category for these patients was inpatient charges, which accounted for almost half of the total. In contrast, pharmacy charges accounted for 13% of the total. The large standard deviations around the means highlight the variability associated with these measures, especially for inpatient charges, and although most of the patients incurred no charges, a few incurred high costs. Although there was a high degree of variability around the point estimates, they were similar overall, indicating that the patient groups did not differ with respect to use of medical resources (data not shown).

After the initial anxiety diagnosis and anxiolytic prescription, treatment charges increased an average of approximately 50% to $9270/patient after the index date compared with the period before the index date ( Table 4 ). Although inpatient charges increased 39% over the time period, pharmacy charges increased 101%, accounting for 18% of the total and confirming the trend in increased drug therapy mentioned above. All before-after comparisons were statistically significant at an a level of 0.05, which highlights the impact of anxiety on the total cost of treatment for these patients.


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