Comparative analysis of drug action on B-cell proliferation and differentiation for mycophenolic acid, everolimus, and prednisolone.
Comparative analysis of drug action on B-cell proliferation and differentiation for mycophenolic acid, everolimus, and prednisolone.
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DOI：
10.1097/01.tp.0000441826.70687.f6
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发表时间：
2014-02-27
期刊：
影响因子：
6.2
通讯作者：
Kobayashi T
中科院分区：
文献类型：
--
作者：
Haneda M;Owaki M;Kuzuya T;Iwasaki K;Miwa Y;Kobayashi T
评估实体器官移植（SOT）患者人群中带状疱疹（HZ）的医疗保健利用和费用。使用行政索赔数据，确定了1999年1月1日至2007年1月1日期间患有SOT的商业/医疗保险患者人群，以及1999年1月1日至2006年1月1日期间的医疗补助人群。对每个患者组进行筛选，以选择声称SOT且事件诊断为HZ的患者，并在事件HZ之前6个月和之后3个月连续入组。使用倾向评分匹配过程，从无HZ声明的SOT患者组中选择对照。进行描述性分析，以量化卫生保健的利用和成本归因于HZ。多变量分析用于估计HZ归因成本调整人口统计学和临床变量。共选择了205个商业/医疗保险匹配对和136个医疗补助匹配对。商业/医疗保险SOT-HZ人群的平均年龄为56.9岁，医疗补助人群的平均年龄为42.5岁。大多数HZ患者在SOT证据的2年内被诊断。商业/医疗保险和医疗补助患者的总医疗费用的未调整差异分别为4762美元和6705美元（分别为P=0.176和P=0.003），主要是由住院费用驱动的。SOT-HZ商业/医疗保险患者的调整后增量成本为5335美元（P<0.001），而非医疗补助患者的调整后增量成本为3711美元（P<0.001）。在SOT免疫功能低下的患者中发生HZ显著增加了医疗保健利用率和成本。
To evaluate health-care utilization and costs attributable to herpes zoster (HZ) within a population of patients with solid organ transplant (SOT). Using administrative claims data, a commercially/Medicare-insured population of patients with SOT between January 1, 1999, and January 1, 2007, and a Medicaid population between January 1, 1999, and January 1, 2006, were identified. Each patient group was screened to select patients with claims of SOT with an incident diagnosis of HZ and continuous enrollment for the 6 months prior and 3 months subsequent to the incident HZ. Controls were selected from group of SOT patients without claims of HZ using a propensity score matching process. Descriptive analyses were performed to quantify health-care utilization and costs attributable to HZ. Multivariate analyses were used to estimate HZ-attributable costs adjusted by demographic and clinical variables. A total of 205 commercially/Medicare-insured matched pairs and 136 Medicaid matched pairs were selected. Mean age in the commercial/Medicare SOT-HZ population was 56.9 years, and that in the Medicaid population was 42.5 years. The majority of HZ patients were diagnosed within 2 years of evidence of SOT. The unadjusted differences in total HZ-attributable health-care costs were $4762 and $6705 for commercial/Medicare-insured and Medicaid patients, respectively (P=0.176 and P=0.003, respectively) and were largely driven by hospitalization costs. Adjusted incremental costs in the SOT-HZ commercial/Medicare-insured patients were $5335 (P<0.001), and that in noncapitated Medicaid patients were $3711 (P<0.001). The occurrence of HZ in patients immunocompromised by SOT significantly increased health-care utilization and costs.