Pohl Hans G, Joyce Geoffrey F, Wise Matthew, Cilento Bartley G
Department of Urology, George Washington University, Children's National Medical Center, Washington, DC, USA.
J Urol. 2007 May;177(5):1659-66. doi: 10.1016/j.juro.2007.01.059.
We quantified the burden of vesicoureteral reflux and ureteroceles in the United States by identifying trends in the use of health care resources and estimating the economic impact of the diseases.
The analytical methods used to generate these results were described previously.
Annual inpatient hospitalizations for vesicoureteral reflux increased slightly between 1994 and 2000 from 6.4/100,000 to 7.0/100,000 children, although this trend did not attain statistical significance. Inpatient hospitalization for ureteroceles remained relatively stable between 1994 and 2000 at an average of approximately 2,818 cases annually (1.0/100,000 to 1.1/100,000 children). The rates of visits to physician offices doubled during the 1990 s for commercially insured children (12/100,000 in 1994 and 26/100,000 in 2002) and children covered by Medicaid (43/100,000 in 1996 and 85/100,000 in 2000). Overall the rate of ambulatory surgery visits by commercially insured children increased from 3.4/100,000 in 1998 to 4.8/100,000 in 2002. Similar estimates were not available for children covered by Medicaid. Emergency room use by children with a primary diagnosis of vesicoureteral reflux was rare, reflecting the trend toward delivery of care at physician offices, ambulatory surgery centers and inpatient hospitals. No reliable data could be obtained on outpatient visits or ambulatory surgery for ureteroceles. In 2000 total expenditures for inpatient pediatric vesicoureteral reflux were $47 million, an increase of more than $10 million since 1997. Based on data from 2000 the yearly national inpatient expenditures from ureterocele treatment were an estimated $4 million.
The economic impact of inpatient treatment for pediatric vesicoureteral reflux is considerable. If other service types such as pharmaceuticals, and outpatient and ambulatory services were considered, the observed impact of this condition would certainly be greater. Importantly the costs of prophylactic medical therapy and emerging therapies such as Deflux are not accounted for in this estimate. Furthermore, indirect economic costs, such as work loss to parents of children with pediatric vesicoureteral reflux, were not considered, causing an even greater underestimation of the true costs associated with the condition. Although the National Association of Children's Hospitals and Related Institutions, and the Health Care Cost and Utilization Project Kids' Inpatient Database include data on ureteroceles, the data were limited and, thus, they could not be used to determine reliable cost trends. Available data indicate that the mean cost per ureterocele case was almost $8,000 with little variation observed across ages, regions or sexes.
通过确定医疗保健资源使用趋势并估算疾病的经济影响，我们对美国膀胱输尿管反流和输尿管囊肿的负担进行了量化。
先前已描述用于得出这些结果的分析方法。
1994年至2000年间，膀胱输尿管反流的年度住院儿童人数略有增加，从每10万名儿童中的6.4例增至7.0例，尽管这一趋势未达到统计学显著性。1994年至2000年间，输尿管囊肿的住院人数相对稳定，平均每年约2818例（每10万名儿童中的1.0例至1.1例）。20世纪90年代，商业保险儿童看医生的比率翻了一番（1994年为每10万人中12次，2002年为每10万人中26次），医疗补助覆盖儿童的看医生比率也翻了一番（1996年为每10万人中43次，2000年为每10万人中85次）。总体而言，商业保险儿童的门诊手术就诊率从1998年的每10万人中3.4次增至2002年的每10万人中4.8次。医疗补助覆盖儿童没有类似的可用估计数据。以膀胱输尿管反流为主要诊断的儿童很少使用急诊室，这反映了在医生办公室、门诊手术中心和住院医院提供护理的趋势。无法获得关于输尿管囊肿门诊就诊或门诊手术的可靠数据。2000年，儿科膀胱输尿管反流的住院总支出为4700万美元，自1997年以来增加了超过1000万美元。根据2000年的数据，输尿管囊肿治疗的全国年度住院支出估计为400万美元。
儿科膀胱输尿管反流住院治疗的经济影响相当大。如果考虑其他服务类型，如药品以及门诊和非住院服务，这种疾病的实际影响肯定会更大。重要的是，本估计未计入预防性药物治疗和诸如Deflux等新兴疗法的成本。此外，未考虑间接经济成本，如儿科膀胱输尿管反流患儿父母的工作损失，这导致对与该疾病相关的真实成本的低估更为严重。尽管美国儿童医院及相关机构协会以及医疗保健成本与利用项目儿童住院数据库包含输尿管囊肿的数据，但数据有限，因此无法用于确定可靠的成本趋势。现有数据表明，每个输尿管囊肿病例的平均成本近8000美元，各年龄、地区或性别之间的差异很小。
