Characterizing the financial burden of pulmonary arterial hypertension within an integrated healthcare delivery system.
Characterizing the financial burden of pulmonary arterial hypertension within an integrated healthcare delivery system.
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DOI：
10.3111/13696998.2013.849713
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发表时间：
2013-12-01
影响因子：
2.4
通讯作者：
Zager, Carol
中科院分区：
文献类型：
--
作者：
Johnson, Samuel;Delate, Thomas;Zager, Carol
目的：肺动脉高压（PAH）患者提供医疗保健相关的经济负担尚不清楚。本研究试图量化3年的医疗保健支出，并确定支出在事件和流行PAH病例之间是否存在差异。方法：这是一项对确诊为PAH的科罗拉多州凯撒医疗机构（KPCO）患者的回顾性队列研究。纳入的患者从研究开始随访至3年、死亡或终止KPCO会员资格，以先到者为准。从KPCO的角度来看，所有支出均以2011年美元为单位。结果：共纳入157例患者，其中常见病44例（28%），发病率113例（72%）。平均年龄（流行病例与发病病例）为61岁对67岁，男性为13.6%对27.4%。大多数患者（55%）被WHO分类为1组PAH。流行病例随访时间较短（843天vs 975天；p=0.033）。总体而言，每位患者每天（PPPD）和3年总支出的中位数分别为56美元(四分位数范围（IQR= 29- 166美元）和50,599美元（IQR= 25,958- 135,535美元）。在调整患者特征和慢性疾病负担后，PPPD中位数（54美元vs 56美元，p=0.950）和3年（37,340美元vs 55,073美元，p=0.111）的总支出在流行病例和事件病例之间相等；然而，在3年随访期间，事件病例的死亡风险较低（风险比=0.41,95% CI=0.18-0.91）。在药房、住院、医疗办公室、急诊科或其他支出方面没有发现显著差异。PAH专业药物PPPD支出中位数也相同（专业药物使用者中226美元vs 223美元；p=0.861）。结论：与多环芳烃相关的医疗支出是巨大的经济负担。流行或事件病例状态的显著差异似乎是由ED和住院费用的中位数驱动的；然而，多环芳烃专科药物支出总体上是一个巨大的成本驱动因素。未来的努力应集中在优化多环芳烃患者的护理，以避免不必要的伤害或浪费。
PURPOSE: Financial burden associated with providing healthcare to patients with pulmonary arterial hypertension (PAH) is poorly characterized. This study sought to quantify 3-year healthcare expenditures and determine whether expenditures differed between incident and prevalent PAH cases.METHODS: This was a retrospective cohort study of Kaiser Permanente Colorado (KPCO) patients with confirmed diagnosis of PAH. Included patients were followed from study entry until 3 years, death, or termination of KPCO membership, whichever came first. All expenditures were reported in 2011 US dollars from the KPCO perspective.RESULTS: In total, 157 patients were included: 44 (28%) prevalent and 113 (72%) incident cases. Mean age (prevalent vs incident cases) was 61 years vs 67 years and 13.6% vs 27.4% were males. The majority of patients (55%) were classified as WHO Group 1 PAH. Prevalent cases had less follow-up (843 vs 975 days; p=0.033). Overall, median total per patient per day (PPPD) and 3-year total expenditures were $56 (interquartile range (IQR=$29-$166) and $50,599 (IQR=$25,958-$135,535), respectively. After adjustment for patient characteristics and chronic disease burden, median PPPD ($54 vs $56; p=0.950) and 3-year ($37,340 vs $55,073; p=0.111) total expenditures were equivalent between prevalent and incident cases; however, the risk of death during the 3-year follow-up was lower among incident cases (hazard ratio=0.41, 95% CI=0.18-0.91). No significant differences were detected in pharmacy, inpatient, medical office, emergency department, or other expenditures. Median PAH specialty medication PPPD expenditures were also equivalent, also ($226 vs $223 among specialty medication users; p=0.861).CONCLUSION: Healthcare expenditures related to PAH represent substantial financial burden. Significant differences according to prevalent or incident case status appeared to be driven by median ED and inpatient expenditures; however, PAH specialty medication expenditures represented a substantial cost-driver overall. Future efforts should focus on optimizing care for patients with PAH to avoid unnecessary harm or waste.