Green Peter H R, Neugut Alfred I, Naiyer Afzal J, Edwards Z Collette, Gabinelle Susan, Chinburapa Vijit
Celiac Disease Center, Columbia University College of Physicians and Surgeons, Harkness Pavilion, 180 Fort Washington, Suite 956, New York, NY 10032, USA.
J Insur Med. 2008;40(3-4):218-28.
To estimate the rate of celiac disease diagnosis and evaluate the economic benefits of diagnosis by analyzing retrospective cohorts from a national managed-care-population database.
We identified patients who received a new diagnosis of celiac disease. We also identified 3 control groups, persons without a diagnosis of celiac disease but who exhibited 1, 2, or 3 or more symptoms associated with the disease. Using claims, encounter, and eligibility data of approximately 10.2 million managed care members across the United States between January 1999 and December 2003, we measured and compared direct standardized relative value based (RVU) medical costs and utilization of selected health care services among the 4 study cohorts.
The rate of new diagnosis for celiac disease more than doubled over the 4-year period. The celiac disease cohort had a significant trend reduction in direct standardized medical costs relative to the three control groups. RVU-based medical costs in the celiac cohort were 24%, 33%, and 27% lower than cohort 1 (p<0.05), 29.0%, 38%, and 24% lower than cohort 2 (p<0.05), and 38%, 33%, and 31% lower than cohort 3 (p<0.01) for the 12-month, 24-month and 36-month post-diagnosis periods, respectively. The reductions in costs were attributable to decreasing trends in utilization of office visits, lab, diagnostic, imaging, and endoscopy procedures relative to the 3 comparative cohorts over the 3-year follow-up period.
There was an increase in the rate of celiac disease diagnosis, which was associated with significant reduction in direct standardized RVU-based medical costs and utilization of selected health care services over time.
通过分析来自国家管理式医疗人群数据库的回顾性队列，估算乳糜泻的诊断率并评估诊断的经济效益。
我们确定了新诊断为乳糜泻的患者。我们还确定了3个对照组，即未诊断为乳糜泻但出现1、2或3种及以上与该疾病相关症状的人。利用1999年1月至2003年12月期间美国约1020万管理式医疗成员的理赔、就诊和资格数据，我们测量并比较了4个研究队列中基于直接标准化相对价值单位（RVU）的医疗费用以及选定医疗服务的使用情况。
在4年期间，乳糜泻的新诊断率增加了一倍多。与三个对照组相比，乳糜泻队列的直接标准化医疗费用有显著下降趋势。在诊断后的12个月、24个月和36个月期间，乳糜泻队列基于RVU的医疗费用分别比第1组低24%、33%和27%（p<0.05），比第2组低29.0%、38%和24%（p<0.05），比第3组低38%、33%和31%（p<0.01）。成本的降低归因于在3年随访期内，与3个比较队列相比，门诊就诊、实验室检查、诊断、影像和内镜检查的使用趋势下降。
乳糜泻的诊断率有所上升，这与基于直接标准化RVU的医疗费用和选定医疗服务的使用随时间显著降低有关。
