Crown William H, Bresnahan Brian W, Orsini Lucinda S, Kennedy Sean, Leonardi Craig
Medstat, Cambridge, MA 02140, USA.
Curr Med Res Opin. 2004 Dec;20(12):1929-36. doi: 10.1185/030079904X15192.
To evaluate utilization and direct healthcare expenditures among psoriasis patients treated with systemic therapy and phototherapy in the United States.
Cohort study using retrospective administrative medical claims.
Psoriasis patients treated with systemic therapy and phototherapy, as well as a matched cohort of non-psoriasis patients. All patients were covered by employer-sponsored insurance between 1 April 1996 and 31 December 2000.
Estimated risk of hospitalization and total annual healthcare expenditures overall and by comorbidity status were compared for persons with psoriasis using systemic therapy or phototherapy and persons without psoriasis. Annualized utilization rates for hospitalizations, and use of emergency department, outpatient physician, outpatient laboratory, and outpatient pharmaceutical services were also compared across the two cohorts.
Seventeen percent of psoriasis patients were treated with systemic therapy or phototherapy. Patients with comorbid anemia, carcinoma, diabetes, depression, GI disorders, hepatotoxicity, hypertension, and nephrotoxicity had significantly higher expenditures than non-psoriasis patients with the same comorbidities (p < or =0.05). Elevated risk of hospitalization also contributed to higher expenditures in patients treated with systemic therapy or phototherapy. Limitations of this study include those inherent in using claims data such as dependence on diagnosis coding, the fact that psoriasis severity cannot be determined directly from claims data, confounding comorbidities, and the fact that only direct healthcare expenditures were considered in this analysis.
Psoriasis patients treated with systemic therapies/phototherapies have significantly more comorbidities and higher mean total healthcare expenditures compared to non-psoriasis patients. Psoriasis patients with selected comorbidities have significantly higher mean total healthcare expenditures compared to non-psoriasis persons with the same comorbidities.
评估美国接受系统治疗和光疗的银屑病患者的医疗服务利用情况及直接医疗支出。
采用回顾性管理医疗索赔的队列研究。
接受系统治疗和光疗的银屑病患者，以及匹配的非银屑病患者队列。所有患者在1996年4月1日至2000年12月31日期间由雇主赞助的保险覆盖。
比较使用系统治疗或光疗的银屑病患者与未患银屑病的患者总体以及按合并症状态划分的住院估计风险和年度总医疗支出。还比较了两个队列的住院年化使用率以及急诊科、门诊医生、门诊实验室和门诊药品服务的使用情况。
17%的银屑病患者接受了系统治疗或光疗。合并贫血、癌症、糖尿病、抑郁症、胃肠道疾病、肝毒性、高血压和肾毒性的患者的支出显著高于患有相同合并症的非银屑病患者（p≤0.05）。住院风险升高也导致接受系统治疗或光疗的患者支出增加。本研究的局限性包括使用索赔数据所固有的局限性，如依赖诊断编码、无法直接从索赔数据确定银屑病严重程度、合并症混淆以及本分析仅考虑了直接医疗支出。
与非银屑病患者相比，接受系统治疗/光疗的银屑病患者合并症显著更多，平均总医疗支出更高。与患有相同合并症的非银屑病患者相比，患有特定合并症的银屑病患者平均总医疗支出显著更高。
