Health Care Utilization and Costs of Idiopathic Pulmonary Fibrosis in US Medicare Beneficiaries Aged 65 Years and Older
Health Care Utilization and Costs of Idiopathic Pulmonary Fibrosis in US Medicare Beneficiaries Aged 65 Years and Older
复制标题
DOI：
10.1513/annalsats.201412-553oc
复制
发表时间：
2015-07-01
影响因子：
8.3
通讯作者：
Raghu, Ganesh
中科院分区：
文献类型：
--
作者：
Collard, Harold R.;Chen, Shih-Yin;Raghu, Ganesh
理由：特发性肺纤维化（IPF）的管理是资源密集型的。由于在美国老年人中发现IPF的患病率不断增加，因此了解该人群中与该疾病相关的经济负担非常重要。目的：比较IPF患者和美国医疗保险（美国最大的老年人支付者）中无IPF的匹配对照受试者之间的医疗保健资源利用和成本。方法：对2000年至2011年5%随机抽样的医疗保险受益人（65岁以上）的行政索赔进行了分析。根据国际疾病分类第九版临床修改诊断代码确定IPF事件患者，在首次诊断（索引日期）之前（索引前）和之后（索引后）至少入组1年。根据年龄、性别、人种和地区，将最多5名无IPF的受益人与每名IPF患者进行匹配。比较了IPF患者和匹配的对照组受试者在索引前和索引后期间的年度卫生保健资源利用和医疗费用（不包括门诊药物费用）。测量和主要结果：共有7，855例IPF患者与38，856例对照组受试者相匹配。与索引前阶段匹配的对照受试者相比，IPF患者的住院风险高82%（28.8 vs. 15.8%），总医疗费用高72%（10，124美元vs. 5，888美元）。在索引后阶段，与匹配的对照受试者相比，IPF患者的住院风险高134%（48.7 vs. 20.8%），急诊室就诊风险增加相似（39.6%对17.5%），总医疗费用高出134%（20，887美元vs. 8，932美元）。结论：在美国医疗保险人群中，IPF患者使用了大量医疗保健资源。美国卫生保健系统每年可归因于IPF的医疗费用（不包括药物费用）估计接近20亿美元。
Rationale: Management of idiopathic pulmonary fibrosis (IPF) is resource-intensive. Because an increasing prevalence of IPF was found among the elderly in the United States, it is important to understand the economic burden associated with the disease in this population.Objectives: To compare health care resource utilization and costs between patients with IPF and matched control subjects without IPF in Medicare, the largest U.S. payer covering the elderly.Methods: Administrative claims from a 5% random sample of Medicare beneficiaries (aged 65+) from years 2000 to 2011 were analyzed. Incident patients with IPF were identified on the basis of International Classification of Diseases, ninth revision, Clinical Modification diagnosis codes, with at least 1 year of enrollment before (preindex) and after (postindex) the first diagnosis (index date). Up to five beneficiaries without IPF were matched to each patient with IPF, based on age, sex, race, and region. Annual health care resource utilization and medical costs (excluding outpatient drug costs) during the preindex and postindex periods were compared between patients with IPF and matched control subjects.Measurements and Main Results: A total of 7,855 patients with IPF were matched to 38,856 control subjects. Compared with matched control subjects during the preindex period, patients with IPF had an 82% higher risk of hospitalization (28.8 vs. 15.8%), and 72% higher total medical costs ($10,124 vs. $5,888). Compared with matched control subjects during the postindex period, patients with IPF had a 134% higher risk of hospitalization (48.7 vs. 20.8%), similar increased risk of emergency room visits (39.6 vs. 17.5%), and 134% higher total medical costs ($20,887 vs. $8,932).Conclusions: In the U.S. Medicare population, patients with IPF incurred substantial health care resource utilization. The annual IPF-attributable medical cost to the U.S. health care system, excluding medication costs, is estimated at close to $2 billion.