Healthcare costs and utilization for privately insured patients treated for non-infectious uveitis in the USA.
Healthcare costs and utilization for privately insured patients treated for non-infectious uveitis in the USA.
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DOI：
10.1186/1869-5760-3-64
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发表时间：
2013-11-06
影响因子：
2.9
通讯作者：
Duh MS
中科院分区：
文献类型：
--
作者：
Chu DS;Johnson SJ;Mallya UG;Davis MR;Sorg RA;Duh MS
这项研究的目的是描述慢性非感染性葡萄膜炎患者使用皮质类固醇、免疫抑制剂或生物制剂的合并症、医疗成本和资源利用情况。在这项回溯性队列研究中，从拥有8070万参保者的私人保险索赔数据库中选择了在6个月基线期间被诊断为非感染性葡萄膜炎并连续投保的患者。索引日期被定义为2003至2009年间首次处方/给药皮质类固醇、免疫抑制剂或生物制剂。在每个成员每月(PMPM)框架内分析合并症、医疗成本和利用率，以考虑患者之间不同的治疗周期，定义为在同一类别内连续用药。使用Wilcoxon秩和检验和卡方检验比较成本和分类结果。服用皮质类固醇(N = 4,568)、免疫抑制剂(N = 5,466)和生物制剂(N = 1,694)的患者组成研究人群。在服用皮质类固醇和免疫抑制剂的患者中，基线的PMPM住院率为0.029，服用免疫抑制剂的患者为0.044，服用生物制剂的患者为0.045(p <； 0.001与皮质类固醇)；在治疗期间，服用皮质类固醇和免疫抑制剂的患者的PMPM住院率分别增加到0.044和0.048，但服用生物制剂的患者的住院率下降到0.024(p <； 0.001与皮质类固醇和p = 0.003与免疫抑制剂)。服用皮质类固醇、免疫抑制剂和生物制品的患者的基线平均PMPM成本分别为935美元、1,738美元和1,439美元(P <； 0.001分组间)，而不包括药品成本的持续治疗PMPM成本增加到1,129美元，但服用免疫抑制剂的患者降至1,592美元，服用生物制剂的患者为918美元(P <； 0.001与皮质类固醇或免疫抑制剂相比)。现有的葡萄膜炎治疗方法带来了巨大的经济负担。皮质类固醇可能被过度用于葡萄膜炎的治疗。
The purpose of this study was to describe comorbidities, healthcare costs, and resource utilization among patients with chronic non-infectious uveitis initiating corticosteroid, immunosuppressants, or biologics. In this retrospective cohort study, patients with a non-infectious uveitis diagnosis and continuous insurance coverage during a 6-month baseline were selected from a privately insured claims database with 80.7 million enrollees. Index dates were defined as the first prescription/administration of a corticosteroid, immunosuppressant, or biologic between 2003 and 2009. Comorbidities, healthcare costs, and utilization were analyzed in a per-member-per-month (PMPM) framework to account for varying between-patient treatment periods, defined as continuous medication use within the same class. Wilcoxon rank-sum and chi-square tests were used for comparisons of costs and categorical outcomes. Patients on corticosteroids (N = 4,568), immunosuppressants (N = 5,466), and biologics (N = 1,694) formed the study population. Baseline PMPM inpatient admission rates were 0.029 for patients on corticosteroids, 0.044 for patients on immunosuppressants, and 0.045 for patients on biologics (p < 0.001 immunosuppressants or biologics versus corticosteroids); during treatment, PMPM inpatient admissions increased to 0.044 and 0.048 for patients taking corticosteroids and immunosuppressants, respectively, but decreased to 0.024 for patients taking biologics (p < 0.001 versus corticosteroids and p = 0.003 versus immunosuppressants). Baseline average PMPM costs for patients taking corticosteroids, immunosuppressants, and biologics were US$935, US$1,738, and US$1,439 (p < 0.001 between groups), while on-treatment PMPM costs excluding drug costs increased to US$1,129 for patients taking corticosteroids but lowered to US$1,592 for patients taking immunosuppressants, and US$918 for patients taking biologics (p < 0.001 versus corticosteroids or immunosuppressants). There is significant economic burden associated with existing treatments of uveitis. Corticosteroids may be overused as a treatment for uveitis.