Predictors of health care costs in adults with diabetes
Predictors of health care costs in adults with diabetes
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DOI：
10.2337/diacare.28.1.59
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发表时间：
2005-01-01
期刊：
影响因子：
16.2
通讯作者：
Solberg, LI
中科院分区：
文献类型：
--
作者：
Gilmer, TP;O'Connor, PJ;Solberg, LI
目的-本研究的目的是评估基线糖化血红蛋白，心血管疾病，抑郁症对随后的医疗保健费用成年人之间的影响与diabetes.RESEARCH设计和方法-一个前瞻性分析进行了患者调查和医疗记录审查合并3年的医疗索赔的数据。费用估计使用详细的数据资源使用和医疗保险支付方法。在调整人口统计学和社会经济学因素后，采用广义线性模型分析与临床预测因素相关的成本。结果-在对1，694名成年糖尿病患者的多变量分析中，冠心病（CHD）和高血压患者的3年成本超过糖尿病患者的300%（46，879美元对14，233美元; P < 0.05）。抑郁症与成本增加50%相关（31，967美元对21，609美元; P < 0.05）。相对于基线Alc为6%的患者，Alc为70%的患者的3年成本高出11%（26，408美元对23，873美元; P < 0.05）。只有基线Alc >7.5%的患者，Alc越高，预测的费用越高（P = 0.015）。结论：在糖尿病、冠心病、高血压和抑郁谱系障碍的成年患者中，Alc水平对未来费用的预测作用比Alc水平更强。在积极努力控制葡萄糖的同时，更大的努力预防或控制CHD、高血压和抑郁症对于控制患有糖尿病的成年人的卫生保健费用是必要的。Diabetes Care 28：59-64，2005。
OBJECTIVE - The purpose of this study was to assess the impact of baseline Alc, cardiovascular disease, and depression on subsequent health care costs among adults with diabetes.RESEARCH DESIGN AND METHODS - A prospective analysis was performed of data from a patient survey and medical record review merged with 3 years of medical claims. Costs were estimated using detailed data on resource use and Medicare payment methodologies. Generalized linear models were used to analyze costs related to clinical predictors after adjusting for demographic and socioeconomic factors.RESULTS - In multivariate analysis of 1,694 adults with diabetes, 3-year costs in those with coronary heart disease (CHD) and hypertension were over 300% of those with diabetes only ($46,879 vs. $14,233; P < 0.05). Depression was associated with a 50% increase in costs ($31,967 vs. $21,609; P < 0.05). Relative to those with a baseline Alc of 6%, those with an Alc of 70% had 3-year costs that were 11% higher ($26,408 vs. $23,873; P < 0.05). Higher Alc predicted higher costs only for those with baseline Alc >7.5% (P = 0.015).CONCLUSIONS - In adults with diabetes, CHD, hypertension, and depression spectrum disorders more strongly predicted future costs than the Alc level. Concurrent with aggressive efforts to control glucose, greater efforts to prevent or control CHD, hypertension, and depression are necessary to control health care costs in adults with diabetes.Diabetes Care 28:59-64, 2005.