Economic value of orthotic and prosthetic services among medicare beneficiaries: a claims-based retrospective cohort study, 2011-2014
Economic value of orthotic and prosthetic services among medicare beneficiaries: a claims-based retrospective cohort study, 2011-2014
复制标题
DOI：
10.1186/s12984-018-0406-7
复制
发表时间：
2018-09-05
影响因子：
5.1
通讯作者：
DaVanzo, Joan E.
中科院分区：
文献类型：
--
作者：
Dobson, Allen;Murray, Kennan;DaVanzo, Joan E.
背景：关于矫形和假肢服务的经济价值的研究很少。先前一项基于2007年至2010年医疗保险A部分和B部分索赔的矫形器和假体医疗保险受益人的队列研究得出结论，及时接受矫形器或假体护理的患者与对照组未接受治疗的患者相比，其医疗保健总成本相当或更低。这项后续研究报告了基于2011年至2014年医疗保险索赔的平行分析，包括D部分以及a部分和B部分的服务和支出。其目的是验证早期的研究结果，即与未接受这些服务的匹配患者相比，接受选择的矫形和假肢服务的医疗保险患者有更少的医疗保健利用率，更低的医疗保险支付和潜在的更少的负面结果。方法：采用2011-2014年医疗保险索赔数据，对78,707对临床需要矫形和假肢服务的医疗保险受益人（N = 157,414）进行回顾性队列分析。它使用倾向评分匹配技术来控制可观察到的选择偏差。在经济方面，进行了为期四年的成本-后果评价。结果：接受下肢矫形治疗的患者18个月发作费用比未接受矫形治疗的患者低1939美元（22,734美元对24,673美元）。接受脊柱矫正治疗的患者18个月发作费用比未接受治疗的患者低2094美元（23560美元对25655美元）。接受两种矫形器的研究组受益人的D部分支出明显低于未接受治疗的组（p < 0.05）。尽管假体的成本相对较高，但接受下肢假体的患者与未接受假体的匹配受益人的15个月发作付款相当（68,877美元vs 68,893美元）。结论：这些结果与之前的研究结果一致，表明矫形和假肢服务为医疗保险计划和患者提供了价值。
Background: There are few studies of the economic value of orthotic and prosthetic services. A prior cohort study of orthotic and prosthetic Medicare beneficiaries based on Medicare Parts A and B claims from 2007 to 2010 concluded that patients who received timely orthotic or prosthetic care had comparable or lower total health care costs than a comparison group of untreated patients. This follow-up study reports on a parallel analysis based on Medicare claims from 2011 to 2014 and includes Part D in addition to Parts A and B services and expenditures. Its purpose is to validate earlier findings on the extent to which Medicare patients who received select orthotic and prosthetic services had less health care utilization, lower Medicare payments, and potentially fewer negative outcomes compared to matched patients not receiving these services.Methods: This is a retrospective cohort analysis of 78,707 matched pairs of Medicare beneficiaries with clinical need for orthotic and prosthetic services (N = 157,414) using 2011-2014 Medicare claims data. It uses propensity score matching techniques to control for observable selection bias. Economically, a cost-consequence evaluation over a four-year time horizon was performed.Results: Patients who received lower extremity orthotics had 18-month episode costs that were $1939 lower than comparable patients who did not receive orthotic treatment ($22,734 vs $24,673). Patients who received spinal orthotic treatment had 18-month episode costs that were $2094 lower than comparable non-treated patients ($23,560 vs $25,655). Study group beneficiaries receiving both types of orthotics had significantly lower Part D spending than those not receiving treatment (p < 0.05). Patients who received lower extremity prostheses had comparable 15-month episode payments to matched beneficiaries not receiving prostheses ($68,877 vs $68,893) despite the relatively high cost of the prosthesis.Conclusions: These results were consistent with those found in the prior study and suggest that orthotic and prosthetic services provide value to the Medicare program and to the patient.