Analysis of Health Care Costs in Elderly Patients with Multiple Chronic Conditions Using a Finite Mixture of Generalized Linear Models
Analysis of Health Care Costs in Elderly Patients with Multiple Chronic Conditions Using a Finite Mixture of Generalized Linear Models
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DOI：
10.1002/hec.3334
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发表时间：
2017-05-01
期刊：
影响因子：
2.1
通讯作者：
Koenig, Hans-Helmut
中科院分区：
文献类型：
--
作者：
Eckardt, Matthias;Brettschneider, Christian;Koenig, Hans-Helmut
在本文中，我们分析了医疗保健费用在老年患者患有多种疾病的样本。一方面，多病个体消耗了不成比例的大量医疗资源。另一方面，在使用传统回归技术时，患者特定数量和同时发生的单一疾病的组合导致数据不均匀，导致估计有偏倚。因此，我们采用混合回归来控制未观察到的异质性，重点是识别多病模式。我们使用了一项多中心前瞻性队列研究（ISRCTN 89818205）中的N=1050名患者的子样本，该研究随机选择了年龄在65至85岁之间的德国多病初级保健患者（ISRCTN 89818205），这些患者在访谈前6个月期间完成了详细的医疗保健利用问卷。纳入了1047种疾病组合。我们在总费用方面发现了四组不同的患者。这些群体在很大程度上符合流行病学文献的发现。额外疾病的存在对成本的影响在各组之间有所不同。此外，就共同发生的疾病的数量而言，发现了两种截然相反的成本趋势。在一组中，费用随着同时发生的疾病数量的增加而增加，而在第二组中，费用趋于减少。版权所有：John Wiley & Sons， Ltd。
In this paper we analysed healthcare costs in a sample of elderly patients suffering from multimorbidity. On the one hand, multimorbid individuals consume a disproportionally large share of healthcare resources. On the other hand, the patient specific number and combination of co-occurring single diseases result in inhomogeneous data leading to biased estimates when using traditional regression techniques. Therefore, we applied a mixture of regressions in order to control for unobserved heterogeneity focussing on the identification of multimorbidity patterns. We used a subsample of N=1050 patients from a multicentre prospective cohort study of randomly selected multimorbid primary care patients aged 65 to 85years in Germany (ISRCTN 89818205) who completed a detailed questionnaire on healthcare utilization during the 6-month period preceding the interview. Disease combinations of 1047 were included. We detected four different groups of patients with regard to total costs. These groups corresponded largely to findings from the epidemiological literature. The effect of the presence of an additional disease on costs differed between groups. Moreover, two diametrically opposed cost trends were detected with respect to the number of co-occurring diseases. While in one group costs increased with the number of co-occurring diseases, in a second group cost tended to decrease. Copyright (c) 2016 John Wiley & Sons, Ltd.