National health care costs of peripheral arterial disease in the Medicare population
National health care costs of peripheral arterial disease in the Medicare population
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DOI：
10.1177/1358863x08089277
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发表时间：
2008-08-01
影响因子：
3.5
通讯作者：
Virnig, Beth A.
中科院分区：
文献类型：
--
作者：
Hirsch, Alan T.;Hartman, Lacey;Virnig, Beth A.
下肢外周动脉疾病(PAD)在医疗保险人群中普遍存在，并与心肌梗死、中风、截肢和死亡的高发生率相关。然而，PAD的全国卫生支出并不清楚。我们假设与PAD相关的费用很高，随着年龄的增长而增加，治疗率将低于已知的PAD流行率。目的是确定美国PAD的全国医疗保健支出。在老年、非残疾的医疗保险人群中计算了与PAD相关的治疗费用。成本分析依赖于2001年相关SEER-Medicare数据和Medicare索赔的5%对照人群，根据诊断和程序代码确定PAD病例。住院和门诊治疗的费用分别汇总，估计数进行了调整，以反映医疗保险人口。在与PAD相关的治疗上总共花费了43.7亿美元，88%的支出用于住院护理。联邦医疗保险计划的总支出为38.7亿美元，而参保人(或他们的补充保险)花费了剩余的5亿美元。总体而言，6.8%的老年医疗保险人口接受了PAD的治疗。在65-74岁、75-84岁和85岁的个体中，随着年龄的增长，治疗率分别为4.5%、7.5%和11.8%。与PAD相关的费用约占接受PAD治疗的队列的所有联邦医疗保险A部分和B部分支出的13%，占联邦医疗保险A部分和B部分总支出的2.3%。总而言之，与住院护理相关的美国国家PAD相关费用很高，而且随着年龄的增长而增加。PAD的治疗率低于已知的PAD患病率，因为在我们的分析中，只有大约三分之一的已知PAD患者有可检测到的与PAD相关的医疗费用。早期PAD检测和门诊预防策略的使用对全国PAD医疗保健总成本的潜在影响尚不清楚。
Lower extremity peripheral arterial disease (PAD) is prevalent in the Medicare population and is associated with high rates of myocardial infarction, stroke, amputation, and death. Nevertheless, national health expenditures for PAD are not known. We hypothesized that PAD-related costs are high, increase with age, and that treatment rates would be less than known PAD prevalence. The objective was to determine national health care expenditures for PAD in the United States. PAD-related treatment costs were calculated in the elderly, non-disabled Medicare population. The cost analysis relied on the 5% control population for the linked SEER-Medicare data and Medicare claims for the calendar year 2001, identifying PAD cases based on diagnosis and procedure codes. Costs were aggregated separately for inpatient and outpatient treatment and estimates adjusted to reflect the Medicare population. A total of $4.37 billion was spent on PAD-related treatment and 88% of expenditures were for inpatient care. Medicare program outlays totaled $3.87 billion, while enrollees (or their supplemental insurance) spent the remaining $500 million. In total, 6.8% of the elderly Medicare population received treatment for PAD. Treatment increased with age at rates of 4.5%, 7.5%, and 11.8% for individuals aged 65-74, 75-84, and >85 years, respectively. PAD-related costs accounted for approximately 13% of all Medicare Part A and B expenditures for the PAD-treated cohort, and 2.3% of total Medicare Part A and B expenditures. In conclusion, US national PAD-related costs are high, associated with inpatient care, and increase with age. PAD is treated at rates lower than the known PAD prevalence as only approximately one-third of the population with known PAD had detectable PAD-related health care costs in our analysis. The potential impact of earlier PAD detection and use of outpatient preventive strategies on total national PAD health care costs is unknown.