An Economic Evaluation of the Impact, Cost, and Medicare Policy Implications of Chronic Nonhealing Wounds.
An Economic Evaluation of the Impact, Cost, and Medicare Policy Implications of Chronic Nonhealing Wounds.
复制标题
DOI：
10.1016/j.jval.2017.07.007
复制
发表时间：
2018-01-01
期刊：
影响因子：
4.5
通讯作者：
Cartwright, Donna
中科院分区：
文献类型：
--
作者：
Nussbaum, Samuel R.;Carter, Marissa J.;Cartwright, Donna
目的：本研究的目的是确定慢性伤口护理的医疗保险受益人的总成本，伤口类型和setting.METHODS：医疗保险5%有限的数据集为日历年2014年的回顾性分析包括受益人谁经历了以下一个或多个护理事件：动脉溃疡、慢性溃疡、糖尿病足溃疡、糖尿病感染、压力性溃疡、皮肤病、皮肤感染、手术伤口、手术感染、创伤性伤口、静脉溃疡或静脉感染。主要结果是每种伤口类型的患病率，每种伤口类型的医疗保险支出和总支出，以及按服务类型划分的支出。结果：近15%的医疗保险受益人（820万）至少有一种类型的伤口或感染（非肺炎）。手术感染是最大的患病率类别（4.0%），其次是糖尿病感染（3.4%）。所有伤口类型的医疗保险总支出估计从281亿美元到968亿美元不等。包括感染成本在内，最昂贵的估计是手术伤口（117亿美元，131亿美元和383亿美元），其次是糖尿病足溃疡（62亿美元，69亿美元和187亿美元）。最高的成本估计方面的网站的服务是为医院门诊（9.9 - 35.8亿美元），其次是医院住院病人（5.0 - 24.3亿美元）。结论：医疗保险支出有关伤口护理远远大于以前认识到的，护理主要发生在门诊设置。这些数据可用于开发更合适的质量措施和报销模式，这是为不断增长的人口提供更好的健康结果和更明智的支出所必需的。版权所有（c）2018国际药物经济学和结局研究学会（ISPOR）。爱思唯尔公司出版版权所有
OBJECTIVE: The aim of this study was to determine the cost of chronic wound care for Medicare beneficiaries in aggregate, by wound type and by setting.METHODS: This retrospective analysis of the Medicare 5% Limited Data Set for calendar year 2014 included beneficiaries who experienced episodes of care for one or more of the following: arterial ulcers, chronic ulcers, diabetic foot ulcers, diabetic infections, pressure ulcers, skin disorders, skin infections, surgical wounds, surgical infections, traumatic wounds, venous ulcers, or venous infections. The main outcomes were the prevalence of each wound type, Medicare expenditure for each wound type and aggregate, and expenditure by type of service.RESULTS: Nearly 15% of Medicare beneficiaries (8.2 million) had at least one type of wound or infection (not pneumonia). Surgical infections were the largest prevalence category (4.0%), followed by diabetic infections (3.4%). Total Medicare spending estimates for all wound types ranged from $28.1 to $96.8 billion. Including infection costs, the most expensive estimates were for surgical wounds ($11.7, $13.1, and $38.3 billion), followed by diabetic foot ulcers ($6.2, $6.9, and $18.7 billion,). The highest cost estimates in regard to site of service were for hospital outpatients ($9.9-$35.8 billion), followed by hospital inpatients ($5.0-$24.3 billion).CONCLUSIONS: Medicare expenditures related to wound care are far greater than previously recognized, with care occurring largely in outpatient settings. The data could be used to develop more appropriate quality measures and reimbursement models, which are needed for better health outcomes and smarter spending for this growing population. Copyright (c) 2018 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved