Direct Economic Burden of Chronic Hepatitis C Virus in a United States Managed Care Population
Direct Economic Burden of Chronic Hepatitis C Virus in a United States Managed Care Population
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DOI：
10.1097/mcg.0b013e3181e12c09
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发表时间：
2011-02-01
影响因子：
2.9
通讯作者：
Rustgi, Vinod
中科院分区：
文献类型：
--
作者：
Davis, Keith L.;Mitra, Debanjali;Rustgi, Vinod
目的和背景：评估慢性丙型肝炎病毒（HCV）管理式医疗登记患者的全因和疾病相关资源利用和成本。研究：分析了一个大型美国索赔数据库（2002年1月1日至2006年12月31日）。纳入标准为：诊断为慢性HCV；没有乙型肝炎诊断；>= 6, >=诊断前和诊断后连续计划入组12个月。评估了诊断后12个月期间医疗服务和处方药的使用情况和费用。在没有HCV匹配（1:1）的年龄、性别和计划入组的对照组中评估结果。所有成本估算都是使用多元广义线性模型生成的，以调整医疗保健成本数据中常见的附加协变量和偏度。结果：符合所有纳入标准的20662例患者中，平均年龄为49岁；61%为男性。调整后的全因成本为每位HCV患者20,961美元，而每位对照患者5451美元（P < 0.0001）。24%的HCV患者住院，而对照组为7% （P < 0.0001）。平均住院费用分别为每位患者5892美元和1159美元（P < 0.0001）。与对照组相比，HCV患者的处方费用更高（6191美元vs 1315美元；P < 0.0001）。每名患者6864美元，疾病相关费用几乎占HCV患者全部费用的三分之一，比对照组的全因费用高出26% （P < 0.0001）。结论：慢性丙型肝炎是一种昂贵的疾病管理医疗机构。在人口统计学匹配的对照中，HCV的疾病相关成本超过了全因成本。加强丙型肝炎筛查和早期治疗，特别是在进展为肝硬化之前，可能会为管理式医疗系统节省丙型肝炎管理的长期成本。
Goals and Background: To estimate all-cause and disease-related resource utilization and costs among managed care enrollees with chronic hepatitis C virus (HCV).Study: A large United States claims database was analyzed (1/1/ 2002 to 12/31/2006). Inclusion criteria were: diagnosis of chronic HCV; no hepatitis B diagnoses; >= 6 and >= 12 months of continuous plan enrollment prediagnosis and postdiagnosis, respectively. Use and costs of medical services and prescription drugs over a 12-month period postdiagnosis were evaluated. Outcomes were assessed in controls without HCV matched (1: 1) on age, sex, and plan enrollment. All cost estimates were generated using multivariate generalized linear models to adjust for additional covariates and skewness common in health care cost data.Results: Of the 20,662 patients who met all inclusion criteria, mean age was 49 years; 61% were male. Adjusted all-cause costs were $20,961 per HCV patient, compared with $5451 per control (P < 0.0001). Hospitalization occurred in 24% of HCV patients compared with 7% of controls (P < 0.0001). Mean inpatient costs were $5892 and $1159 per patient, respectively (P < 0.0001). Patients with HCV had higher prescription costs compared with controls ($6191 vs. $1315; P < 0.0001). At $6864 per patient, disease-related costs were nearly one-third of all costs in patients with HCV, which exceeded all-cause costs among controls by 26% (P < 0.0001).Conclusions: Chronic HCV is a costly disease to managed care organizations. Disease-related costs in HCV exceed all-cause costs in demographically matched controls. Increased efforts in HCV screening and early treatment, particularly before progression to liver cirrhosis, may lead to long-term cost savings in HCV management for managed care systems.