The One-Year Attributable Cost of Post-stroke Dysphagia
The One-Year Attributable Cost of Post-stroke Dysphagia
复制标题
DOI：
10.1007/s00455-014-9543-8
复制
发表时间：
2014-10-01
期刊：
影响因子：
2.6
通讯作者：
Simpson, Kit
中科院分区：
文献类型：
--
作者：
Bonilha, Heather Shaw;Simpson, Annie N.;Simpson, Kit
随着最近对循证实践和医疗改革的重视，了解吞咽困难管理的成本从未如此重要。这有助于临床医生了解和客观报告与吞咽困难相关的成本，当他们提倡在这种经济的服务。在仔细估计疾病成本之后，需要投入成本效益分析，以帮助支持治疗的价值。本研究试图通过检查南卡罗来纳卒中后吞咽困难诊断相关的1年费用来解决这一问题。此外，本研究还调查了脑卒中后吞咽困难的成本是否存在种族和居住地差异。本研究回顾性纳入了2004年南卡罗来纳州医疗保险数据库中3200名患有缺血性卒中ICD-9编码（434和436）的患者的数据。比较卒中后吞咽困难患者和非吞咽困难患者在年龄、性别、种族、死亡率、住院时间、合并症、农村情况、出院处理和医疗保险费用等方面的差异。完成了单变量分析和带对数链接函数的伽马分布广义线性多变量模型。我们发现，在控制年龄、合并症、种族和存活时间比例的情况下，缺血性卒中后吞咽困难患者的1年医疗保险费用比缺血性卒中后无吞咽困难患者高4,510美元。单因素分析显示，卒中后吞咽困难患者的农村、种族和性别差异无统计学意义。卒中后吞咽困难显著增加卒中后医疗费用。了解与卒中后吞咽困难相关的支出有助于优化资源的分配和使用。进行成本效益研究需要这些资料。
With the recent emphasis on evidence-based practice and healthcare reform, understanding the cost of dysphagia management has never been more important. It is helpful for clinicians to understand and objectively report the costs associated with dysphagia when they advocate for their services in this economy. Having carefully estimated cost of illness, inputs are needed for cost-effectiveness analyses that help support the value of treatments. This study sought to address this issue by examining the 1-year cost associated with a diagnosis of dysphagia post-stroke in South Carolina. Furthermore, this study investigated whether ethnicity and residence differences exist in the cost of dysphagia post-stroke. Data on 3,200 patients in the South Carolina Medicare database from 2004 who had ICD-9 codes for ischemic stroke, 434 and 436, were retrospectively included in this study. Differences between persons with and without dysphagia post-stroke were compared with respect to age, gender, ethnicity, mortality, length of stay, comorbidity, rurality, discharge disposition, and cost to Medicare. Univariate analyses and a gamma-distributed generalized linear multivariable model with a log link function were completed. We found that the 1-year cost to Medicare for persons with dysphagia post ischemic stroke was $4,510 higher than that for persons without dysphagia post ischemic stroke when controlling for age, comorbidities, ethnicity, and proportion of time alive. Univariate analysis revealed that rurality, ethnicity, and gender were not statistically significantly different in comparisons of individuals with or without dysphagia post-stroke. Post-stroke dysphagia significantly increases post-stroke medical expenses. Understanding the expenditures associated with post-stroke dysphagia is helpful for optimal allocation and use of resources. Such information is needed to conduct cost-effectiveness studies.