Burden of illness: direct and indirect costs among persons with hemophilia A in the United States
Burden of illness: direct and indirect costs among persons with hemophilia A in the United States
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DOI：
10.3111/13696998.2015.1016228
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发表时间：
2015-01-01
影响因子：
2.4
通讯作者：
Nichol, Michael B.
中科院分区：
文献类型：
--
作者：
Zhou, Zheng-Yi;Koerper, Marion A.;Nichol, Michael B.
目的：研究美国血友病A患者的血友病护理的直接和间接成本。方法：观察数据来自HUGS-Va，这是一项来自6家联邦政府支持的血友病治疗中心（HTC）的多中心研究。符合条件的个人完成了标准化的初始问卷，并定期随访2年，以获得有关工作或学校缺勤，安排血友病护理所花费的时间以及照顾者提供的无偿血友病相关支持的信息。来自1年医疗保健利用记录和2年凝血因子分配记录的数据测量了直接医疗成本。间接成本估算使用人力资本的方法，它使用工资作为工作时间output.Results的代理措施：共有222例完整的数据被纳入分析。三分之二的患者患有严重血友病，平均年龄为21.1岁。与接受间歇性治疗的患者相比，在重度血友病患者中使用预防性治疗与急诊（艾德）就诊次数和出血事件发生次数的统计学显著性减少相关。从社会角度来看，轻度血友病每人每年花费59，101美元（中位数：7519美元），中度血友病84，363美元（中位数：61，837美元），重度血友病201，471美元（中位数：143，431美元），接受预防性治疗的重度血友病301，392美元（中位数：286，198美元）。凝血因子的贡献从54%的总费用在轻度血友病的最高94%的严重血友病接受prophylaxis.Conclusion：血友病是一个昂贵的疾病，不仅因为其高昂的医疗费用，但也由于产生的间接费用高。
Objective:To examine the direct and indirect costs of hemophilia care among persons with hemophilia A in the US. Methods: Observational data were obtained from HUGS-Va, a multi-center study from six federally supported hemophilia treatment centers (HTCs). Eligible individuals completed a standardized initial questionnaire and were followed regularly for 2 years to obtain information on work or school absenteeism, time spent arranging hemophilia care, and unpaid hemophilia-related support from caregivers. Data from 1-year healthcare utilization records and 2-year clotting factor dispensing records measured direct medical costs. Indirect costs were imputed using the human capital approach, which uses wages as a proxy measure of work time output.Results:A total of 222 patients with complete data were included in the analysis. Two-thirds had severe hemophilia and the mean age was 21.1 years. The use of prophylaxis in severe hemophilia patients is associated with statistically significant reduction in the numbers of emergency department (ED) visits and bleeding episodes compared with those who were treated episodically. From the societal perspective, mild hemophilia costs $59,101 (median: $7519) annually per person, $84,363 (median: $61,837) for moderate hemophilia, $201,471 (median: $143,431) for severe hemophilia using episodic treatment, and $301,392 (median: $286,198) for severe hemophilia receiving prophylaxis. Clotting factor contributed from 54% of total costs in mild hemophilia to a maximum of 94% for patients with severe hemophilia receiving prophylaxis.Conclusion:Hemophilia is a costly disorder not only because of its high medical expenses, but also due to the high indirect costs incurred.