The Cost of Crohn's Disease: Varied Health Care Expenditure Patterns Across Distinct Disease Trajectories.
The Cost of Crohn's Disease: Varied Health Care Expenditure Patterns Across Distinct Disease Trajectories.
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DOI：
10.1097/mib.0000000000000977
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发表时间：
2017-01
影响因子：
4.9
通讯作者：
Binion DG
中科院分区：
文献类型：
--
作者：
Rao BB;Click BH;Koutroubakis IE;Ramos Rivers C;Regueiro M;Swoger J;Schwartz M;Hashash J;Barrie A;Dunn MA;Binion DG
克罗恩病（CD）患者包括异质性疾病谱，具有可变的医疗保健利用和支出模式。Lémann指数（LI）是量化累积性肠损伤的指标，并已显示出在描绘不同疾病表型方面的实用性。描述CD队列中与基于LI的疾病表型变异相关的所有医疗护理的经济负担。纳入了前瞻性登记研究中随访5年的CD患者。根据首次（LI 1）和末次（LI 2）临床就诊计算LI。评分变化（LI 2-LI 1）或Delta LI（DLI）用于与医疗费用的相关性分析。共有243例CD患者构成研究人群[中位年龄44岁; 58%为女性;中位病程12年]。DLI用于定义疾病轨迹：DLI<0（表明肠损伤改善）; DLI=0（稳定）; DLI>0（恶化）;分别占队列的15.6%、30.9%和53.5%。与其他组相比，DLI>0的患者具有显著更高的CD相关手术、医疗保健利用、药物（类固醇和生物制剂）使用以及更高的中位5年总费用和分层费用。5年总支出为5600万美元;其中67%与住院有关。总费用与LI 2（p=0.001）和DLI（p=0.001）呈独立正相关，与年龄（p=0.029）和5年生活质量评分（p=0.024）呈负相关。CD的经济负担与肠损伤恶化显著相关。进一步的研究应该集中在最昂贵/最病态的CD患者的预测和管理。
Patients with Crohn's disease (CD) encompass a heterogeneous disease spectrum, with variable healthcare utilization and expenditure patterns. Lémann Index (LI) is a metric that quantifies cumulative bowel damage and has shown utility in delineating distinct disease phenotypes. To characterize the financial burden from all medical care in a CD cohort in relation to variations in LI-based disease phenotypes. CD patients with 5 year(y) follow-up from a prospective registry were included. LI was calculated from first (LI1) and last (LI2) clinical encounters. Change in score (LI2-LI1) or Delta LI (DLI) was used for association analysis with healthcare expenditures. A total of 243 CD patients formed the study population [median age 44y; 58% female; median disease duration 12y]. DLI was used to define disease trajectories: DLI<0 (indicating improving bowel damage); DLI=0 (stable); DLI>0 (worsening); which comprised 15.6%, 30.9% and 53.5% of the cohort respectively. Patients with DLI>0 had significantly higher CD-related surgeries, healthcare utilization, medication (steroids and biologics) use as well as higher median 5y total and stratified charges compared to the other groups. Total 5y expenditure was $56 million; 67% of which was related to hospitalization. Total expense showed independent positive correlation with LI2 (p=0.001) and DLI (p=0.001), and negative correlation with age (p=0.029) and 5y quality of life score (p=0.024). The financial burden of CD is significantly associated with worsening bowel damage. Further research should focus on the prediction and management of the costliest/sickest CD patients.