Clinical course and costs of care for Crohn's disease: Markov model analysis of a population-based cohort
Clinical course and costs of care for Crohn's disease: Markov model analysis of a population-based cohort
复制标题
DOI：
10.1016/s0016-5085(99)70549-4
复制
发表时间：
1999-07-01
期刊：
影响因子：
29.4
通讯作者：
Zinsmeister, AR
中科院分区：
文献类型：
--
作者：
Silverstein, MD;Loftus, EV;Zinsmeister, AR
背景与目标：克罗恩病导致高发病率和高卫生服务使用率。本研究的目的是描述明尼苏达州奥姆斯特德县克罗恩病患者的 24 年初始队列中克罗恩病的终生临床病程和费用。方法：通过药物和手术治疗来定义疾病状态。马尔可夫模型分析计算了每种疾病状态的时间以及与年龄和性别匹配的队列相比的超额生命成本的现值。结果：对于代表性患者，使用中位费用预计每位患者的终生成本为 39,906 美元，使用平均费用则为 125,404 美元。有 29.1 年（占总数的 63%）没有服药。氨基水杨酸盐治疗 12.7 年 (27%)，产生费用 11,467 美元 (29%)；皮质类固醇或免疫抑制治疗 3.2 年 (7%)，产生费用 5147 美元 (13%)。手术产生了 17,526 美元 (44%) 的费用。结论：大部分临床过程是在药物或手术的缓解中度过的。氨基水杨酸盐治疗占护理费用的 29%。手术费用最高，但缓解时间最长。诱导轻度疾病缓解并通过低成本维持治疗维持缓解的治疗策略将对患者的治疗结果和费用产生最大的影响。
Background & Aims: Crohn's disease results in substantial morbidity and high use of health services. The aim of this study was to describe the lifetime clinical course and costs of Crohn's disease in a 24-year population based inception cohort of patients with Crohn's disease in Olmsted County, Minnesota. Methods: Disease states were defined by medical and surgical treatment. A Markov model analysis calculated time in each disease state and present value of excess lifetime costs in comparison with an age- and sex-matched cohort. Results: For a representative patient, projected lifetime costs were $39,906 per patient using median charges and $125,404 using mean charges. There were 29.1 years (63% of total) without medications. There were 12.7 years (27%) on aminosalicylate therapy, generating $11,467 (29%) in charges, and 3.2 years (7%) on corticosteroid or immunosuppressive therapy, generating $5147 (13%) in charges. Surgery generated $17,526 (44%) in charges. Conclusions: Most of the clinical course is spent in remission, either medical or surgical. Aminosalicylate therapy accounts for 29% of the costs of care. Surgery has the highest charges but the longest remissions. Treatment strategies that induce remission in mild disease and maintain remission with lower-cost maintenance therapy will have the largest effect on patient outcomes and costs.