Xuan J, Duong P T, Russo P A, Lacey M J, Wong B
Department of Health Economics and Outcomes Research, SmithKline Beecham Pharmaceuticals, Philadelphia, PA 19101, USA.
Am J Manag Care. 2000 Jun;6(6):693-700.
To examine the economic burden of and treatment patterns for congestive heart failure (CHF) in a managed care population.
Retrospective review of medical and pharmacy claims.
We reviewed integrated medical and pharmacy claims data from 6 independent-practice-association model health maintenance organizations to identify patients diagnosed with CHF. Of the approximately 1.4 million people enrolled in these managed care plans during the study period (January through December 1994), a total of 2777 patients (mean age, 56.9 years) met the study criteria, which included diagnostic codes for CHF and claims eligibility of at least 1 year. We reviewed the charges incurred by patients diagnosed with CHF for the 6 months after the initial CHF medical claim. We also examined the treatment received by each of these patients.
During the study period, 378 of the 2777 patients with CHF (14%) were admitted to the hospital at a cost of almost $3 million (an average of $7863 per hospitalized patient). Seventy-eight percent of the study population received prescription drugs, at an average per-patient cost of $942. The most commonly prescribed drug class was angiotensin-converting enzyme inhibitors, prescribed for 38% of patients. Calcium channel blockers were prescribed for 33% of patients, but beta-blockers were prescribed for only 18% of patients. Hospitalization accounted for 54% of the total cost for CHF treatment, with prescription drugs accounting for 38%.
Congestive heart failure represents a significant financial burden within a non-elderly managed care population. Improved management of the condition is needed to reduce the morbidity and mortality, as well as the costs of treatment, associated with CHF. Considerable data indicate that drugs such as beta-blockers and angiotensin-converting enzyme inhibitors can significantly decrease the morbidity and mortality of CHF. Further investigation is needed into whether increased use of prescription pharmaceuticals may reduce hospitalization rates and overall costs for CHF in this setting.
研究管理式医疗人群中充血性心力衰竭（CHF）的经济负担及治疗模式。
对医疗和药房理赔记录进行回顾性分析。
我们回顾了6个独立执业协会模式的健康维护组织的综合医疗和药房理赔数据，以确定被诊断为CHF的患者。在研究期间（1994年1月至12月），参与这些管理式医疗计划的约140万人中，共有2777名患者（平均年龄56.9岁）符合研究标准，其中包括CHF诊断代码以及至少1年的理赔资格。我们回顾了被诊断为CHF的患者在首次CHF医疗理赔后的6个月内产生的费用。我们还检查了这些患者每人接受的治疗。
在研究期间，2777名CHF患者中有378名（14%）入院治疗，费用近300万美元（每名住院患者平均7863美元）。78%的研究人群接受了处方药治疗，每名患者的平均费用为942美元。最常开具的药物类别是血管紧张素转换酶抑制剂，38%的患者使用该药物。33%的患者使用钙通道阻滞剂，但只有18%的患者使用β受体阻滞剂。住院费用占CHF治疗总费用的54%，处方药费用占38%。
充血性心力衰竭在非老年管理式医疗人群中代表着巨大的经济负担。需要改善对该病的管理，以降低与CHF相关的发病率、死亡率以及治疗成本。大量数据表明，β受体阻滞剂和血管紧张素转换酶抑制剂等药物可显著降低CHF的发病率和死亡率。在这种情况下，是否增加处方药的使用可降低CHF的住院率和总体成本，还需要进一步研究。
