Rates and costs of invasive pneumococcal disease and pneumonia in persons with underlying medical conditions.
Rates and costs of invasive pneumococcal disease and pneumonia in persons with underlying medical conditions.
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DOI：
10.1186/s12913-016-1432-4
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发表时间：
2016-05-13
影响因子：
2.8
通讯作者：
Pelton SI
中科院分区：
文献类型：
--
作者：
Weycker D;Farkouh RA;Strutton DR;Edelsberg J;Shea KM;Pelton SI
正如最近两项评估所表明的那样，已知某些潜在医疗条件的存在会增加所有年龄段和各种条件下的人患肺炎球菌疾病的风险。相应的可归属经济成本估计数尚未得到很好的描述。因此，我们进行了一项回顾性评估，以估计美国有和没有基础医疗条件的儿童和成人肺炎球菌疾病的发病率和费用。数据来自三个独立的医疗保健索赔库。研究人群包括2007-2010年期间参加健康计划的所有人员，并根据年龄和风险特征分为亚组：健康;由于选定的合并症而处于风险中;由于选定的免疫功能低下而处于高风险中。通过诊断、程序和药物代码确定高危和高危疾病，以及侵袭性肺炎球菌病（IPD）和全因肺炎（PNE）发作。使用发病率比（IRR）和成本比，将高危和高危人群的IPD和PNE（2010年美元）的发生率和医疗费用与年龄分层的健康人群进行比较。所有年龄段的高危人群（IRR = 4.1 [95% CI 3.9-4.3]和4.5 [4.49-4.53]）和高危人群（IRR = 10.3 [9.7-11.0]和8.2 [8.2-8.3]）的IPD和PNE发生率始终高于健康人群。患有≥2种疾病（IRR = 9.0 [8.4-9.7]和10.3 [10.3-10.4]）以及哮喘（IRR = 3.4 [3.0-3.8]和4.5 [4.47-4.53]）或糖尿病（IRR = 4.3 [4.0-4.6]和4.7 [4.6-4.7]）的高危人群的发生率明显较高。每100，000高危人群年的医疗保健费用总计为2170万美元，每100，000高危人群年为5850万美元，分别是健康人群相应费用的8.7 [8.5-8.8]和23.4 [22.9-23.8]倍。患有某些慢性和免疫功能低下疾病的人的IPD和PNE的费用和费用远远高于没有任何此类疾病的人。哮喘和糖尿病患者的费用和成本尤其增加，患有≥2种高危疾病的患者的费用和成本接近高危人群。本文的在线版本（doi：10.1186/s12913-016-1432-4）包含补充材料，可供授权用户使用。
The presence of certain underlying medical conditions is known to increase the risk of pneumococcal disease in persons of all ages and across a wide spectrum of conditions, as demonstrated in two recent evaluations. Corresponding estimates of attributable economic costs have not been well characterized. We thus undertook a retrospective evaluation to estimate rates and costs of pneumococcal disease among children and adults with and without underlying medical conditions in the United States. Data were obtained from three independent healthcare claims repositories. The study population included all persons enrolled in participating health plans during 2007–2010, and was stratified into subgroups based on age and risk profile: healthy; at-risk, due to selected comorbid conditions; and high-risk, due to selected immunocompromising conditions. At-risk and high-risk conditions, as well as episodes of invasive pneumococcal disease (IPD) and all-cause pneumonia (PNE), were identified via diagnosis, procedure, and drug codes. Rates and healthcare costs of IPD and PNE (2010US$) among at-risk and high-risk persons were compared with those from age-stratified healthy counterparts using incidence rate ratios (IRR) and cost ratios. Rates of IPD and PNE were consistently higher among at-risk persons (IRR = 4.1 [95 % CI 3.9–4.3] and 4.5 [4.49–4.53]) and high-risk persons (IRR = 10.3 [9.7–11.0] and 8.2 [8.2–8.3]) of all ages versus their healthy counterparts. Rates were notably high for at-risk persons with ≥2 conditions (IRR = 9.0 [8.4–9.7] and 10.3 [10.3–10.4]), as well as those with asthma (IRR = 3.4 [3.0–3.8] and 4.5 [4.47–4.53]) or diabetes (IRR = 4.3 [4.0–4.6] and 4.7 [4.6–4.7]). Healthcare costs totaled $21.7 million per 100,000 at-risk person-years and $58.5 million per 100,000 high-risk person-years, which were 8.7 [8.5–8.8] and 23.4 [22.9–23.8] times higher than corresponding costs for healthy persons. Rates and costs of IPD and PNE are substantially higher among persons with certain chronic and immunocompromising conditions versus those without any such conditions. Rates and costs for persons with asthma and diabetes were especially increased, and rates and costs for individuals with ≥2 at-risk conditions approached those among persons with high-risk conditions. The online version of this article (doi:10.1186/s12913-016-1432-4) contains supplementary material, which is available to authorized users.