Effect of asthma exacerbations on health care costs among asthmatic patients with moderate and severe persistent asthma
Effect of asthma exacerbations on health care costs among asthmatic patients with moderate and severe persistent asthma
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DOI：
10.1016/j.jaci.2012.01.039
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发表时间：
2012-05-01
影响因子：
14.2
通讯作者：
McLaurin, Kimmie
中科院分区：
文献类型：
--
作者：
Ivanova, Jasmina I.;Bergman, Rachel;McLaurin, Kimmie
背景资料：更严重哮喘患者的医疗保健费用增加，但哮喘急性发作对更严重哮喘患者费用的影响尚未量化。目的：本研究比较了中度/重度持续性哮喘伴和不伴急性发作患者的直接医疗保健费用。方法：哮喘诊断患者（国际疾病分类-第九次修订-临床修改代码493.x），年龄为12 - 64岁，和正在接受控制器治疗的人是从一个大型的行政索赔数据库中确定的。患者被归类为中度/重度持续性哮喘，并在12个月的急性发作识别期内进一步评价急性发作。根据人口统计学特征和哮喘严重程度，将发生1次或多次急性加重（哮喘相关住院或急诊就诊或皮质类固醇处方）的患者与未发生急性加重的患者进行匹配。结果：急性发作患者的总医疗费用（9223美元对5011美元，P <0.0001）和哮喘相关费用（1740美元对847美元，P <0.0001）显著高于急性发作患者。通过使用多变量模型控制患者差异后，成本差异仍然显着。急性发作患者（n = 3830）的鼻窦炎、过敏相关诊断或药物、肺炎和精神障碍的发生率较高，基线时的平均Charlson合并症指数评分较高。急性发作的患者填写他们的处方控制器更频繁，有较高的哮喘相关的药物costs.Conclusions：中度/重度持续性哮喘患者有急性发作的总费用和哮喘相关的医疗费用高于那些没有急性发作。此外，控制性药物的使用在急性加重患者中更高。（J Allergy Clin Immunol 2012;129：1229-35.）
Background: Health care costs increase in patients with more severe asthma, but the effect of asthma exacerbations on costs among patients with more severe asthma has not been quantified.Objective: This study compared direct health care costs between patients with moderate/severe persistent asthma with and without exacerbations.Methods: Patients who had an asthma diagnosis (International Classification of Diseases-ninth revision-Clinical Modification code 493.x), were 12 to 64 years old, and were receiving controller therapy were identified from a large administrative claims database. Patients were categorized as having moderate/severe persistent asthma and were further evaluated for exacerbations during a 12-month exacerbation identification period. Patients with 1 or more exacerbations (asthma-related inpatient or emergency department visit or corticosteroid prescription) were matched to patients without exacerbations on demographic characteristics and asthma severity. Total and asthma-related health care costs during the 1-year study period after the exacerbation index date were calculated.Results: Patients with exacerbations had significantly higher total health care costs ($9223 vs $5011, P < .0001) and asthma-related costs ($1740 vs $847, P < .0001). The cost differences remained significant after controlling for patient differences by using multivariate models. Patients with exacerbations (n = 3830) had higher rates of sinusitis, allergy-related diagnoses or medications, pneumonia, and mental disorders and higher average Charlson Comorbidity Index scores at baseline. Patients with exacerbations filled their prescriptions for controllers more often and had higher asthma-related drug costs.Conclusions: Patients with moderate/severe persistent asthma who had exacerbations had higher total and asthma-related health care costs than those without exacerbations. Moreover, controller medication use was higher in patients with exacerbations. (J Allergy Clin Immunol 2012;129:1229-35.)