Health care utilization and costs associated with direct-acting antivirals for patients with substance use disorders and chronic hepatitis C.
Health care utilization and costs associated with direct-acting antivirals for patients with substance use disorders and chronic hepatitis C.
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药物使用障碍和慢性丙型肝炎患者使用直接作用抗病毒药物的相关医疗保健利用率和成本。
DOI：
10.18553/jmcp.2021.27.10.1388
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发表时间：
2021-10
影响因子：
2.1
通讯作者：
Park H
中科院分区：
文献类型：
--
作者：
Jiang X;Vouri SM;Diaby V;Lo-Ciganic W;Parker R;Park H
物质使用障碍（SUD）和慢性丙型肝炎病毒感染（HCV）的患者由于与提供者（例如，对再感染的担忧）相关的多层次问题而获得直接作用的抗病毒药物（DAA）有限;患者（例如，拒绝）;付款人（例如，事先授权）;和卫生系统结构，尽管临床指南建议SUD和HCV患者及时接受DAA治疗。DAA对这些患者的实际医疗保健利用和成本的影响尚不清楚。比较接受DAA治疗的SUD和HCV患者（DAA组）与未接受DAA治疗的SUD和HCV患者（非DAA组）的肝脏、SUD和全因发病率相关的医疗服务利用和费用变化。我们使用MarketScan商业和医疗保险补充索赔数据库（2012-2018年）对新诊断的未经HCV治疗的SUD成人进行了回顾性队列研究。我们使用差异中差异分析，按肝硬化状态分层，确定调整后的率比（RoRR），以评估两组治疗前后相对变化的差异。确定了6，266例SUD和HCV患者。在这些同时患有肝硬化的患者中（n = 607），49%（n = 298）开始了DAA治疗HCV，而在没有肝硬化的患者中（n = 5，659），22%（n = 1，219）开始了DAA治疗。对于肝硬化患者（n = 607），DAA组的肝脏相关费用减少了6，213美元（95% CI =-8，571美元，-3，856美元），非DAA组减少了1，585美元（95% CI =-4，659美元，1，490美元）。DAA组的肝脏相关成本率的相对下降幅度大于非DAA组，两组之间的相对变化存在显著差异（RoRR = 0.37，95%CI = 0.19-0.73）。DAA后，两组之间SUD相关访视/费用或全因费用的相对变化无差异。对于无肝硬化的患者（n = 5，659），观察到类似的相关性。此外，SUD相关急诊（艾德）就诊率的相对下降（RoRR = 0.54，95% CI = 0.38-0.77）; SUD相关长期护理访视（RoRR = 0.30，95% CI = 0.13-0.73）;全因艾德访视（RoRR = 0.75，95% CI = 0.64-0.88）; DAA组的全因长期护理访视（RoRR = 0.36，95% CI = 0.18-0.72）大于非DAA组。DAA与SUD相关艾德就诊率和肝脏相关费用的显著降低相关，而不会增加SUD和HCV患者的全因费用率，这表明DAA的获益超出了肝脏相关结局，尤其是在该弱势人群中。探索性治疗有效性研究
Patients with substance use disorders (SUD) and chronic hepatitis C virus infection (HCV) have limited access to direct-acting antivirals (DAAs) due to multilevel issues related to providers (eg, concern about reinfection); patients (eg, refusal); payers (eg, prior authorization); and health system structure, although clinical guidelines recommend timely DAA treatment for patients with SUD and HCV. Effects of DAAs on real-world health care utilization and costs among these patients is unknown. To compare changes in medical service utilization and costs related to liver, SUD, and all-cause morbidity in patients with SUD and HCV treated with DAAs (DAA group) vs not treated with DAAs (non-DAA group). We conducted a retrospective cohort study using MarketScan Commercial and Medicare Supplemental Claims databases (2012–2018) for newly diagnosed HCV treatment-naive adults with SUD. We used difference-in-differences analyses, stratified by cirrhosis status, to determine the adjusted ratio of rate ratio (RoRR) to assess the difference in the relative changes from the pre- to posttreatment periods between the 2 groups. 6,266 patients with SUD and HCV were identified. Of these patients who also had cirrhosis (n = 607), 49% (n = 298) initiated DAA therapy for HCV, whereas of those without cirrhosis (n = 5,659), 22% (n = 1,219) initiated DAAs. For patients with cirrhosis (n = 607), the liver-related costs decreased by $6,213 (95% CI = −$8,571, −$3,856) for the DAA group and $1,585 (95% CI = −$4,659, $1,490) for the non-DAA group. The relative decreases in the rate of liver-related costs were larger for the DAA group than for the non-DAA group, and the relative changes between groups were significantly different (RoRR = 0.37, 95% CI = 0.19–0.73). There was no difference in the relative changes after DAAs in the rate of SUD-related visits/costs or all-cause costs between the 2 groups. For patients without cirrhosis (n = 5,659), a similar association was observed. Besides, the relative decreases in the rate of SUD-related emergency department (ED) visits (RoRR = 0.54, 95% CI = 0.38–0.77); SUD-related long-term care visits (RoRR = 0.30, 95% CI = 0.13–0.73); all-cause ED visits (RoRR = 0.75, 95% CI = 0.64–0.88); and all-cause long term-care visits (RoRR = 0.36, 95% CI = 0.18–0.72) were larger in the DAA group than in the non-DAA group. DAAs are associated with a significant decrease in the rate of SUD-related ED visits and liver-related costs without increasing the rate of all-cause costs among patients with SUD and HCV, suggesting that the benefits of DAAs extended beyond liver-related outcomes, especially in this disadvantaged population. Exploratory Treatment Effectiveness Study
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影响因子：
6.6
作者：
Beil, Heather;Feinberg, Rose K.;Romaire, Melissa A.
通讯作者：
Romaire, Melissa A.
DOI：
10.1161/circoutcomes.113.000359
发表时间：
2013-09-01
期刊：
Circulation. Cardiovascular quality and outcomes
影响因子：
--
作者：
Brookhart MA;Wyss R;Layton JB;Stürmer T
通讯作者：
Stürmer T
影响因子：
2.4
作者：
Fuster D;Sanvisens A;Bolao F;Rivas I;Tor J;Muga R
通讯作者：
Muga R
影响因子：
39.2
作者：
Dore, Gregory J.;Altice, Frederick;Platt, Heather L.
通讯作者：
Platt, Heather L.
影响因子：
3.9
作者：
Butner, Jenna L.;Gupta, Neil;Tetrault, Jeanette M.
通讯作者：
Tetrault, Jeanette M.