贫血与心力衰竭医疗费用的关系。
Relationship between anemia and health care costs in heart failure.
机构信息
Division of Cardiology, University of Colorado Denver, Aurora, Colorado 80045, USA.
出版信息
J Card Fail. 2009 Dec;15(10):843-9. doi: 10.1016/j.cardfail.2009.06.435.
BACKGROUND
Anemia is associated with higher morbidity and mortality in patients with heart failure (HF), but its implications for heath care costs are not well described.
METHODS AND RESULTS
We analyzed data on 1056 patients with symptomatic HF seen at Duke University between 2002 and 2006. Health care costs were obtained from the hospital cost accounting data system. Adjustments for censoring and covariate imbalance were performed using inverse probability weighted estimators and propensity scores. The prevalence of anemia was 32%. Unadjusted mortality at 3 years was 50.3% in anemic versus 26.5% in non-anemic patients. The adjusted costs per year alive were $22,926 for patients with anemia and $17,189 for those without (P=.04). For those with ejection fraction <or=40% adjusted costs per year alive were $32,914 for anemic versus $18,423 for non-anemic patients (P=.01).
CONCLUSIONS
Anemia in HF patients was independently associated with greater total costs after accounting for differences in survival, but appeared to be confined primarily to patients with low ejection fraction. These results provide a framework for understanding the economic implications of therapies for anemia in heart failure, and suggest that targeting patients with impaired systolic function has the potential to most favorably affect costs.
背景
贫血与心力衰竭（HF）患者的发病率和死亡率升高有关，但它对医疗保健费用的影响尚未得到很好的描述。
方法和结果
我们分析了 2002 年至 2006 年期间在杜克大学就诊的 1056 例有症状 HF 患者的数据。医疗保健费用来自医院成本核算数据系统。使用逆概率加权估计量和倾向评分对删失和协变量不平衡进行了调整。贫血的患病率为 32%。未调整的 3 年死亡率为贫血患者为 50.3%，非贫血患者为 26.5%。调整后的每年存活成本分别为贫血患者为 22926 美元，非贫血患者为 17189 美元（P=.04）。对于射血分数≤40%的患者，贫血患者的每年存活调整成本为 32914 美元，而非贫血患者为 18423 美元（P=.01）。
结论
在考虑生存差异后，HF 患者的贫血与总费用增加独立相关，但似乎主要局限于射血分数较低的患者。这些结果为理解心力衰竭贫血治疗的经济意义提供了框架，并表明针对收缩功能障碍患者具有潜在的有利影响成本。
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