Determining initial and follow-up costs of cardiovascular events in a US managed care population
Determining initial and follow-up costs of cardiovascular events in a US managed care population
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DOI：
10.1186/1471-2261-11-11
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发表时间：
2011-03-16
影响因子：
2.1
通讯作者：
Straka, Robert J.
中科院分区：
文献类型：
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作者：
Chapman, Richard H.;Liu, Larry Z.;Straka, Robert J.
背景资料：心血管（CV）事件在全球范围内普遍存在，并且在事件发生时的直接医疗费用和事件发生后的随访医疗保健方面都很昂贵。本研究的目的是确定初始和后续成本的心血管（CV）事件在美国管理的医疗enrollees和比较匹配的患者没有CV events.Methods的医疗费用：一个5.5年的回顾性匹配队列分析索赔记录的成人入组者在类似的90个美国健康计划。从包含商业保险美国人群代表性样本的数据库中确定因首次CV事件住院的患者。CV事件组（n = 29，688）与具有相似人口统计学特征但无CV相关事件索赔的对照组相匹配。终点为住院和门诊服务以及药房的直接医疗总费用（已付保险金额）。总体而言，平均初始住院费用为16，981美元/例（标准差[SD] = 20，474美元），范围从短暂性脑缺血发作的6，699美元（平均住院时间[LOS] = 3.7天）至冠状动脉旁路移植术（CABG）的56，024美元（平均LOS = 9.2天）。1年随访期间的总体平均医疗费用为16，582美元（SD = 34，425美元），比匹配对照组的平均费用多出13，792美元。经过2年和3年的随访，CV事件受试者和匹配对照受试者之间的平均成本差异为20，862美元和26，014美元。第二次事件的平均总住院费用与第一次事件相似（17,705美元/例; SD = 22,703美元）。调整人口统计学和临床特征的多变量回归模型表明，CV事件的存在与总随访费用呈正相关（P < 0.0001）。结论：不同类型的CV事件的初始住院和随访费用差异很大。心血管事件的1年随访费用几乎与初始住院费用一样高，但2年和3年随访费用要高得多。
Background: Cardiovascular (CV) events are prevalent and expensive worldwide both in terms of direct medical costs at the time of the event and follow-up healthcare after the event. This study aims to determine initial and follow-up costs for cardiovascular (CV) events in US managed care enrollees and to compare to healthcare costs for matched patients without CV events.Methods: A 5.5-year retrospective matched cohort analysis of claims records for adult enrollees in similar to 90 US health plans. Patients hospitalized for first CV event were identified from a database containing a representative sample of the commercially-insured US population. The CV-event group (n = 29,688) was matched to a control group with similar demographics but no claims for CV-related events. Endpoints were total direct medical costs for inpatient and outpatient services and pharmacy (paid insurance amount).Results: Overall, mean initial inpatient costs were US dollars ($) 16,981 per case (standard deviation [SD] = $ 20,474), ranging from $ 6,699 for a transient ischemic attack (mean length of stay [LOS] = 3.7 days) to $ 56,024 for a coronary artery bypass graft (CABG) (mean LOS = 9.2 days). Overall mean health-care cost during 1-year follow-up was $ 16,582 (SD = $ 34,425), an excess of $ 13,792 over the mean cost of matched controls. This difference in average costs between CV-event and matched-control subjects was $ 20,862 and $ 26,014 after two and three years of follow-up. Mean overall inpatient costs for second events were similar to those for first events ($ 17,705/case; SD = $ 22,703). The multivariable regression model adjusting for demographic and clinical characteristics indicated that the presence of a CV event was positively associated with total follow-up costs (P < 0.0001).Conclusions: Initial hospitalization and follow-up costs vary widely by type of CV event. The 1-year follow-up costs for CV events were almost as high as the initial hospitalization costs, but much higher for 2- and 3-year follow-up.