Cost of medical care for chronic kidney disease and comorbidity among enrollees in a large HMO population
Cost of medical care for chronic kidney disease and comorbidity among enrollees in a large HMO population
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DOI：
10.1097/01.asn.0000125670.64996.bb
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发表时间：
2004-05-01
影响因子：
13.6
通讯作者：
Brown, JB
中科院分区：
文献类型：
--
作者：
Smith, DH;Gullion, CM;Brown, JB
慢性肾病（CKD）困扰着美国多达2000万人，但人们对他们的医疗保健费用知之甚少。作者通过使用国家肾脏基金会分期定义分析了与CKD相关的成本和资源使用。从1996年起，对通过大型健康维护组织投保的实验室检查结果为CKD（定义为1996年估计的GFR为15 - 90 ml/min/1.73 En 2，随后在至少90 d后进行的下一次肌酐测量时第二次GFR低于90）的患者进行长达66个月的随访。最后一个队列包括13，796名CKD患者及其年龄和性别匹配的对照组; 1741名处于第2阶段; 11，278名处于第3阶段; 777名处于第4阶段。根据阶段的不同，病例的处方量是对照组的1.9至2.5倍，门诊量是对照组的1.3至1.9倍，住院时间是对照组的1.6至2.2倍，住院时间是对照组的1.8至3.1倍。每例患者的总随访费用为[病例组和对照组的总费用（95%CI）分别为] 38，764美元（95% CI，37，033 - 40，496美元）和16，212美元（95% CI，15，644美元至16，780美元），第2阶段; 33，144美元（95% CI，32，578美元至33，709美元）和18，964美元（95%CI，$18，730至$19，197）;以及41，928（95%CI，$39，354至$44，501）和19，106（95%CI，$18，212至$20，000）。无CKD相关合并症的病例的成本是无CKD相关合并症的对照组的两倍，与CKD相关的合并症的管理成本高于单独的CKD。这一领域的未来研究可能有助于分析更好地管理或预防CKD患者合并症的临床和经济后果。
Chronic kidney disease (CKD) afflicts up to 20 million people in the United States, but little is known about their health care costs. The authors analyzed costs and resource use associated with CKD by using National Kidney Foundation staging definitions. Patients insured through a large health maintenance organization with a laboratory finding of CKD (defined as estimated GFR between 15 and 90 ml/min per 1.73 En 2 in 1996 followed by a second GFR below 90 at the next creatinine measurement occurring at least 90 d later) were followed from 1996 for up to 66 mo. The final cohort included 13,796 persons with CKD and their age- and gender-matched controls; 1741 in stage 2; 11,278 in stage 3; and 777 in stage 4. Depending on stage, cases had 1.9 to 2.5 times more prescriptions, 1.3 to 1.9 times more outpatient visits, were 1.6 to 2.2 times more likely to have had an inpatient stay, and had 1.8 to 3.1 more stays than did controls. Total per patient follow-up costs were [$total, (95% CI) cases and controls, respectively] $38,764 (95% CI, 37,033 to $40,496) and $16,212 (95% CI, $15,644 to $16,780) in stage 2; $33,144 (95% CI, $32,578 to $33,709) and $18,964 (95% CI, $18,730 to $19,197) in stage 3; and $41,928 (95% CI, $39,354 to $44,501) and $19,106 (95% CI, $18,212 to $20,000) in stage 4. Cases with no CKD-related comorbidities had costs double that of controls with no CKD-related comorbidities, and comorbidities related to CKD were more costly to manage than CKD alone. Future research in this area could be usefully directed toward analyzing the clinical and economic consequences of better managing or preventing comorbidities in patients with CKD.