Frytak Jennifer R, Henk Henry J, Zhao Yang, Bowman Lee, Flynn Jennifer A, Nelson Michael
i3 Innovus, Eden Prairie, MN, USA.
Alzheimers Dement. 2008 Sep;4(5):361-7. doi: 10.1016/j.jalz.2008.02.007. Epub 2008 Apr 21.
The objective of this study was to assess the disease burden of Alzheimer's disease (AD) in a commercial managed care setting by comparing direct health care costs and adverse event outcomes between patients with AD and without AD.
The study design used eligibility, medical, and pharmacy claims data from a large, national, geographically diverse, fee-for-service U.S. managed health plan. Commercially insured patients aged 65 years and older with a pharmacy benefit with evidence of AD (n = 4,450) and a control group without AD (n = 13,650) were matched by age, gender, plan location, and length of enrollment. Adverse event outcomes, comorbid conditions, and annualized health care costs were compared. Incremental costs were calculated by using a two-part model to estimate the burden of illness; incremental cost confidence intervals were estimated by bootstrap analysis.
Patients with AD had generally higher health care costs and higher risk of acute adverse outcomes than the control cohort. Annual adjusted total health care costs per patient were approximately $1,418 greater for the AD cohort. Patients with AD had an unadjusted fracture risk of 14.6% versus 6.2% in the matched cohort and accidental injury/falls risk of 27.4% versus 11.4%.
Few studies have examined the disease burden of AD in commercial managed care settings. Similar to results of comparative studies with Medicare data, the disease burden is greater for patients with AD compared with a matched control cohort, with a different mix and a greater number of comorbid health care conditions partially accounting for this difference. As membership in commercial and Medicare managed care plans increases, plans will need to develop effective mechanisms to manage the health care of high-risk, high-cost patients with AD.
本研究的目的是通过比较患有和未患有阿尔茨海默病（AD）的患者之间的直接医疗保健成本和不良事件结果，评估商业管理式医疗环境中AD的疾病负担。
本研究设计使用了来自美国一个大型、全国性、地域多样的按服务收费的商业健康保险计划的资格、医疗和药房索赔数据。年龄在65岁及以上、有药房福利且有AD证据的商业保险患者（n = 4450）和无AD的对照组（n = 13650）按年龄、性别、计划地点和参保时长进行匹配。比较了不良事件结果、合并症情况和年度医疗保健成本。使用两部分模型计算增量成本以估计疾病负担；通过自助分析估计增量成本置信区间。
与对照组相比，AD患者总体医疗保健成本更高，急性不良后果风险更高。AD队列中每位患者的年度调整后总医疗保健成本比对照组大约高1418美元。AD患者未调整的骨折风险为14.6%，而匹配队列中为6.2%；意外伤害/跌倒风险为27.4%，而匹配队列中为11.4%。
很少有研究在商业管理式医疗环境中研究AD的疾病负担。与使用医疗保险数据的比较研究结果相似，与匹配的对照组相比，AD患者的疾病负担更大，不同的合并症组合和更多的合并医疗状况部分解释了这种差异。随着商业和医疗保险管理式医疗计划的参保人数增加，这些计划将需要制定有效的机制来管理高危、高成本AD患者的医疗保健。
