Direct medical costs and their predictors in patients with rheumatoid arthritis - A three-year study of 7,527 patients
Direct medical costs and their predictors in patients with rheumatoid arthritis - A three-year study of 7,527 patients
复制标题
DOI：
10.1002/art.11439
复制
发表时间：
2003-10-01
影响因子：
--
通讯作者：
Wolfe, F
中科院分区：
文献类型：
--
作者：
Michaud, K;Messer, J;Wolfe, F
objective.估计类风湿关节炎（RA）患者的直接医疗费用总额，并描述这些费用的预测因素。从1999年1月至2001年12月，参与RA结局纵向研究的患者（n = 7，527）完成了25，050份半年期问卷。从这些数据中，我们确定了使用消费者价格指数转换为2001年美元的直接医疗保健成本。我们使用广义估计方程来研究成本的潜在预测因素。通过蒙特卡罗模拟和敏感性分析来评估生物治疗的患病率和成本。2001年，RA患者的平均年度直接医疗护理总成本为9，519美元。药物费用为6，324美元（占总数的66%），而住院费用仅为1，573美元（17%）。大约25%的患者接受了生物治疗。接受生物制剂治疗的患者的平均年直接费用为19，016美元，而未接受生物制剂治疗的患者的费用为6，164美元。根据健康评估问卷测量，处于功能状态最差四分位数的RA患者在随后一年的直接医疗费用比最佳四分位数的患者多5，022美元。由简表36身体成分量表确定的身体状况对RA成本有类似的大影响，合并症也是如此。医疗保险类型发挥的作用较为有限。然而，那些没有保险的人的服务利用率和费用大大降低，健康维护组织的病人的药物费用和总医疗费用较低。受教育年限的增加、收入的增加和多数民族的地位都与药物费用的增加有关，但与住院费用无关。所有类别的费用在65岁后下降。估计病人的直接医疗费用。RA的成本大大高于生物治疗时代之前的成本估计，现在的成本主要由药物成本（主要是生物制剂）驱动。功能差的类风湿关节炎患者继续承担更高的费用，那些与共病的条件，社会人口特征也发挥了重要作用，在确定成本。
Objective. To estimate total direct medical costs in persons with rheumatoid arthritis (RA) and to characterize predictors of these costs.Methods. Patients (n = 7,527) participating in a longitudinal study of outcome in RA completed 25,050 semiannual questionnaires from January 1999 through December 2001. From these we determined direct medical care costs converted to 2001 US dollars using the consumer price index. We used generalized estimating equations to examine potential predictors of the costs. Monte Carlo simulations and sensitivity analyses were performed to evaluate the varying prevalence and cost of biologic therapy.Results. The mean total annual direct medical care cost in 2001 for a patient with RA was $9,519. Drug costs were $6,324 (66% of the total), while hospitalization costs were only $1,573 (17%). Approximately 25% of patients received biologic therapy. The mean total annual direct cost for patients receiving biologic agents was $19,016 per year, while the cost for those not receiving biologic therapy was $6,164. RA patients who were in the worst quartile of functional status, as measured by the Health Assessment Questionnaire, experienced direct medical costs for the subsequent year that were $5,022 more than the costs incurred by those in the best quartile. Physical status as determined by the Short Form 36 physical component scale had a similar large effect on RA costs, as did comorbidity. Medical insurance type played a more limited role. However, those without insurance had substantially lower service utilization and costs, and health maintenance organization patients had lower drug costs and total medical costs. Increased years of education, increased income, and majority ethnic status were all associated with increased drug costs but not hospitalization costs. Costs in all categories decreased after age 65 years.Conclusion. Estimates of direct medical costs for patients with. RA are substantially higher than cost estimates before the biologic therapy era, and costs are now driven predominantly by the cost of drugs, primarily biologic agents. RA patients with poor function continue to incur substantially higher costs, as do those with comorbid conditions, and sociodemographic characteristics also play an important role in determination of costs.