Longitudinal Changes in Medical Services and Related Costs in a Single Cohort of Patients Newly Diagnosed With Type 2 Diabetes, 2006 to 2012
Longitudinal Changes in Medical Services and Related Costs in a Single Cohort of Patients Newly Diagnosed With Type 2 Diabetes, 2006 to 2012
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DOI：
10.1016/j.clinthera.2016.03.032
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发表时间：
2016-06-01
影响因子：
3.2
通讯作者：
Bouchard, Jonathan
中科院分区：
文献类型：
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作者：
Weng, Wayne;Liang, Yuanjie;Bouchard, Jonathan
目的：记录随时间推移的糖尿病治疗模式和相关成本，是在现实世界中衡量当前治疗指南的医疗和经济影响的重要步骤。这项研究旨在评估在新诊断的2型糖尿病(T2 DM)后6年内药物治疗模式、医疗保健费用和合并症的变化。这项分析是第一次观察随着时间的推移，美国新诊断的T2 DM患者的单一队列。方法：这项研究使用Truven Health Analytics MarketScan(R)数据库中的索赔数据，对2006年新诊断为T2 DM的单个队列(N=35,017)成年人的医疗服务变化和并发症进行了纵向评估。每年从指数(诊断)年(Y1)到后指数(Y6)分析糖尿病相关合并症的患病率以及住院/门诊服务和药物的利用/费用。结果：从第一年到第六年，几种与T2 DM相关的合并症的患病率有所增加：脑血管疾病(13%-21%)、外周血管疾病(3%-10%)、肾病(3%-13%)和视网膜病变(4%-14%)。分析了从指数年(Y1)到Y6指数(调整为2012美元)的住院和门诊服务和药物的全因成本。卫生保健总利用成本(服务和药品)从第一年(3.298亿美元)增加到第六年(4.395亿美元)，增幅为33.3%。整个队列的住院费用增加了19.3%，从1年(4980万美元；每个患者1421美元)到第6年(5940万美元；1695美元)，但在使用者中增加了46.6%，尽管住院使用者(7.3%到5.9%的患者)有所下降。门诊使用率保持稳定(Y1，98.2%；Y6，97.2%)，但总就诊人次增加了9.1%。门诊服务成本增加了32.5%，从1.45亿美元(Y1)增加到1.92亿美元(Y6)。药品总成本从1.015亿美元(Y1)增加到1.147亿美元(Y6)，但占所有医疗保健成本的比例在Y6比Y1要小(26.1%比30.7%)。抗糖尿病药物在第一年(3.6%)和第六年(5.3%)的总成本中只占一小部分。影响：总体而言，我们发现有证据表明，与医疗服务成本的大幅增加平行的是，医疗服务成本的大幅增加，但处方成本的增加较少。这些发现证实了积极的糖尿病管理的必要性，以减缓疾病的进展，并将疾病的合并症和经济负担降至最低。(C)2016 Elsevier HS Journal，Inc.版权所有。
Purpose: Documenting diabetes treatment patterns and associated costs over time is an important step in gauging the medical and economic impact of current treatment guidelines in a real-world setting. This study was designed to assess changes in medication treatment patterns, health care costs, and comorbidities over a 6-year period after a new diagnosis of type 2 diabetes mellitus (T2DM). This analysis is the first of its kind to observe, over time, a single US cohort of patients newly diagnosed with T2DM.Methods: This study was a longitudinal assessment of changes in medical services and comorbidities for a single cohort (N = 35,017) of adults newly diagnosed with T2DM in 2006 using claims data from Truven Health Analytics MarketScan (R) databases. Prevalence of diabetes related comorbidities and utilization/costs of inpatient/outpatient services and medications were analyzed annually for the index (diagnosis) year (Y1) through year 6 (Y6) postindex. Costs were adjusted to 2012 dollars.Findings: From Y1 to Y6, increased prevalence was noted for several T2DM-associated comorbidities: cerebrovascular disease (13%-21%), peripheral vascular disease (3%-10%), nephropathy (3%-13%), and retinopathy (4%-14%). All-cause costs of inpatient and outpatient services and medications were analyzed for the index year (Y1) through Y6 postindex (adjusted to 2012 dollars). Total health care utilization costs (services plus drugs) increased by 33.3% from Y1 ($329.8 million) to Y6 ($439.5 million). Inpatient costs across the entire cohort increased 19.3% from Y1 ($49.8 million; $1421/patient) to Y6 ($59.4 million; $1695/patient) but increased 46.6% among utilizers, despite a decline in inpatient utilizers (7.3% to 5.9% of patients). The percentage of outpatient services utilizers remained stable (Y1, 98.2%; Y6, 97.2%), but total visits increased by 9.1%. Costs of outpatient services increased by 32.5%, from $145 million (Y1) to $192 million (Y6). Total drug costs increased from $101.5 million (Y1) to $114.7 million (Y6) but accounted for a smaller percentage of all health care costs in Y6 versus Y1 (26.1% vs 30.7%). Antidiabetes drugs accounted for a small percentage of overall costs in both Y1 (3.6%) and Y6 (5.3%).Implications: Overall, we found evidence of increasing comorbidities paralleled by large increases in costs for medical services but less for prescriptions. These findings confirm a need for aggressive diabetes management to slow disease progression and minimize comorbidity and economic burdens of the disease. (C) 2016 Elsevier HS Journals, Inc. All rights reserved.