The long-term direct and indirect economic burden among Parkinson's disease caregivers in the United States
The long-term direct and indirect economic burden among Parkinson's disease caregivers in the United States
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DOI：
10.1002/mds.27579
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发表时间：
2019-02-01
影响因子：
8.6
通讯作者：
Sail, Kavita
中科院分区：
文献类型：
--
作者：
Martinez-Martin, Pablo;Macaulay, Dendy;Sail, Kavita
背景帕金森病是一种进行性、致残性神经退行性疾病，给患者和护理者带来巨大的经济负担。本研究的目的是比较帕金森病患者的照顾者与美国人口统计学匹配的对照组在首次诊断帕金森病后5年内的直接和间接经济负担。方法从私人保险公司索赔数据库中选择1998年1月1日至2014年3月31日期间与帕金森病患者（>= 2种帕金森病诊断;首次诊断为索引日期）相关的投保人（18-64岁），并将其归类为帕金森病照顾者。符合条件的帕金森氏症照顾者与非帕金森氏症依赖者（对照组）的保单持有人以1：5的比例匹配。根据基线特征调整的多变量回归估计直接成本（全因保险成本[医疗和处方]和合并症相关医疗成本;患者自付成本）和间接成本（残疾和医疗相关缺勤成本）。还比较了队列之间的收入进展。结果：共有1211名符合条件的帕金森氏症照顾者（平均年龄56岁，54%为女性）与6055名对照者相匹配。在调整后的分析中，帕金森氏症的照顾者在第1年的全因保险总成本显着较高（8999美元对7117美元）和医疗费用（7081美元对5568美元）（均P < 0.01）和较高的处方费用（1 -5年的范围，2506 -2573美元vs 1405 - 1687美元）和1-5年的总自付费用（1259 -1585美元vs 902 - 1192美元）（均P < 0.01）。帕金森氏症照顾者在第1-3年的调整后间接成本显著较高（第1-3年的范围为2054 - 2464美元vs 1681 - 1857美元;所有P < 0.05），5年的累积收入损失较高（第5年为5967美元vs 2634美元;相互作用P = 0.03）。结论帕金森氏症照顾者的直接和间接费用较高，收入损失较大。(c)2018国际帕金森和运动障碍协会（c）2018作者。出版社：Wiley Periodicals，Inc.国际帕金森和运动障碍协会（International Parkinson and Movement Disorder Society）
Background Parkinson's disease is a progressive, disabling neurodegenerative disorder associated with significant economic burden for patients and caregivers. The objective of this study was to compare the direct and indirect economic burden of Parkinson's patients' caregivers with demographically matched controls in the United States, in the 5 years after first diagnosis of Parkinson's disease. Methods Policyholders (18-64 years old) linked to a Parkinson's disease patient (>= 2 diagnoses of Parkinson's disease; first diagnosis is the index date) from January 1, 1998 to March 31, 2014, were selected from a private-insurer claims database and categorized as Parkinson's caregivers. Eligible Parkinson's caregivers were matched 1:5 to policyholders with a non-Parkinson's dependent (controls). Multivariable regression adjusted for baseline characteristics estimated direct costs (all-cause insurer cost [medical and prescription] and comorbidity-related medical costs; patient out-of-pocket costs) and indirect costs (disability and medically related absenteeism costs). Income progression was also compared between cohorts. Results A total of 1211 eligible Parkinson's caregivers (mean age, 56 years; 54% female) were matched to 6055 controls. In adjusted analyses, Parkinson's caregivers incurred significantly higher year 1 total all-cause insurer costs ($8999 vs $7117) and medical costs ($7081 vs $5568) (both P < 0.01) and higher prescription costs (range for years 1-5, $2506-2573 vs $1405-$1687) and total out-of-pocket costs ($1259-1585 vs $902-$1192) in years 1-5 (all P < 0.01). Parkinson's caregivers had significantly higher adjusted indirect costs in years 1-3 (range for years 1-3, $2054-$2464 vs $1681-$1857; all P < 0.05) and higher cumulative income loss over 5 years ($5967 vs $2634 by year 5; P for interaction = 0.03). Conclusions Parkinson's caregivers exhibited higher direct and indirect costs and greater income loss compared with matched controls. (c) 2018 International Parkinson and Movement Disorder Society (c) 2018 The Authors. Movement Disorders published by Wiley Periodicals, Inc. on behalf of International Parkinson and Movement Disorder Society.