Hospitalization rates and costs of care of patients with sickle-cell anemia in the State of Maryland in the era of hydroxyurea
Hospitalization rates and costs of care of patients with sickle-cell anemia in the State of Maryland in the era of hydroxyurea
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DOI：
10.1002/ajh.20703
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发表时间：
2006-12-01
影响因子：
12.8
通讯作者：
Dover, George J.
中科院分区：
文献类型：
--
作者：
Lanzkron, Sophie;Haywood, Carlton, Jr.;Dover, George J.
羟基尿素(MSH)治疗镰状细胞性贫血(SCA)的多中心研究表明，与服用安慰剂的患者相比，接受羟基尿素(HU)治疗的患者住院时间减少了44%。随后对HU的成本效益进行的一项研究表明，在服用HU的患者中，因痛苦的危象而减少的住院次数占了大部分费用节省。这项研究的目的是检查在马里兰州HU批准后，医院利用率是否出现了预期的下降。我们使用马里兰州卫生服务成本审查委员会收集的数据来获得马里兰州从1995财年到2003财年的SCA出院数据。我们还回顾了2003年间在一所大型大学医院住院的所有成年SCA患者的住院和门诊图表。自从胡批准以来，马里兰州患有SCA的成年人的住院率大幅上升。据估计，从1995年到2003年，马里兰州的住院总费用在通货膨胀的影响下增长了31%，而成年SCA患者的住院费用在通货膨胀的影响下增长了近60%。相比之下，儿科住院率没有显著增加。我们发现，在一家医院，70%的合适的HU候选患者没有服用这种药物。成人SCA患者的医院利用率显著增加。可能有许多因素在这一增长中发挥了作用。似乎涉及的一个因素是HU的利用不足。
The multicenter study of hydroxyurea (MSH) in sickle-cell anemia (SCA) demonstrated that patients treated with hydroxyurea (HU) had a 44% decrease in hospitalizations when compared with those taking placebo. A subsequent study looking at the cost-effectiveness of HU showed that decreased hospitalizations for painful crisis accounted for the majority of cost savings in those taking HU. The purpose of this study was to examine whether the expected decrease in hospital utilization occurred after the approval of HU in Maryland. We used data collected by the Maryland Health Services Cost Review Commission to obtain SCA discharge data for Maryland from FY1995 through FY2003. We also reviewed the inpatient and outpatient charts of all adults with SCA admitted to a large university hospital during 2003. Hospitalization rates for adults with SCA in Maryland have increased significantly since approval of HU. While the total costs of inpatient care in Maryland are estimated to have increased by 31% above inflation from 1995 to 2003, the costs of inpatient care for adult SCA patients has increased by almost 60% above inflation. By comparison, there has been no significant increase in the pediatric hospitalization rate. We found that 70% of patients in one hospital who were appropriate candidates for HU were not taking the medication. Hospital utilization among adults with SCA has increased significantly. There are likely many factors that have played a role in this increase. One factor that appears to be involved is the underutilization of HU.