Frick Kevin D, Walt John G, Chiang Tina H, Doyle John J, Stern Lee S, Katz Laura M, Dolgitser Margarita, Hendlish Sarah K
Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
Ophthalmology. 2008 Jan;115(1):11-7. doi: 10.1016/j.ophtha.2007.02.007. Epub 2007 May 1.
To evaluate total and condition-related charges incurred by blind patients in a managed care population in the United States and compare total charges with those of a matched nonblind cohort.
Retrospective cohort study.
Patients with blindness (N = 10 796) and a 1:1 matched cohort of nonblind patients were selected from a managed care claims database. All study subjects were required to be > or =18 years old at diagnosis (blind patients) or enrollment (nonblind patients) and to have had > or =1 years of continuous follow-up.
Total and pharmacy-related direct medical charges in the first year of follow-up were calculated for both blind and nonblind cohorts. Among blind patients, condition-related charges, charge per treated person, and charge breakdown by age group were calculated. For patients with follow-up extending past 1 year, total charges (both cohorts) and condition-related charges (blind cohort only) were assessed and annualized. Mean and median charges were assessed for blind and nonblind patients within each stratum of matched covariates; a multivariate linear regression assessed the statistical significance of the difference in charges between the 2 cohorts.
Total health care charges in the first year of follow-up and condition-related health care charges in the first year of follow-up for blind patients.
For the blind population (mean age, 52 years [standard deviation (SD), 17.5]), the total mean and median health care charges per person in the first year were $20,677 (SD, $48,835) and $6854, respectively. Total mean and median health care charges per nonblind patient in the first year were $13,321 (SD, $40,059) and $3778, respectively. Condition-related charges among blind patients were substantially lower than total charges, with mean and median charges per person of $4565 (SD, $17,472) and $371, respectively. After adjusting for covariates, blind patients had significantly higher total health care charges in the first year of follow-up than nonblind patients (P<0.0001). Costs of the blind did not differ substantially from costs of the normally sighted in subsequent years of follow-up.
This study demonstrates the substantial direct cost burden of blindness during the first year of follow-up in a managed care population.
评估美国管理式医疗人群中失明患者产生的总费用及与病情相关的费用，并将总费用与匹配的非失明队列患者的费用进行比较。
回顾性队列研究。
从管理式医疗理赔数据库中选取失明患者（N = 10796）以及1:1匹配的非失明患者队列。所有研究对象在诊断时（失明患者）或入组时（非失明患者）需年满18岁及以上，且有1年及以上的连续随访。
计算失明和非失明队列在随访第一年的总医疗费用及与药房相关的直接医疗费用。在失明患者中，计算与病情相关的费用、每位接受治疗患者的费用以及按年龄组划分的费用明细。对于随访时间超过1年的患者，评估总费用（两个队列）和与病情相关的费用（仅失明队列）并进行年化处理。在匹配协变量的每个分层中评估失明和非失明患者的平均和中位数费用；多变量线性回归评估两个队列之间费用差异的统计学显著性。
随访第一年的总医疗费用以及失明患者随访第一年与病情相关的医疗费用。
对于失明人群（平均年龄52岁[标准差（SD），17.5]），第一年每人的总平均医疗费用和中位数医疗费用分别为20677美元（SD，48835美元）和6854美元。非失明患者第一年每人的总平均医疗费用和中位数医疗费用分别为13321美元（SD，40059美元）和3778美元。失明患者中与病情相关的费用显著低于总费用，每人的平均和中位数费用分别为4565美元（SD，17472美元）和371美元。在对协变量进行调整后，失明患者在随访第一年的总医疗费用显著高于非失明患者（P<0.0001）。在后续随访年份中，失明患者的费用与视力正常者的费用没有显著差异。
本研究表明在管理式医疗人群中，失明在随访第一年造成了巨大的直接成本负担。
