Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia.
Clin Ther. 2010 Jan;32(1):119-32; discussion 106-7. doi: 10.1016/j.clinthera.2010.01.009.
The management of atherothrombotic disease is responsible for a large proportion of direct medical costs in most countries, imposing a substantial financial burden on health care payers. There is limited knowledge about direct per-person medical costs using a "bottom-up" approach.
This study was designed to estimate the per-person direct medical costs incurred by communitybased subjects in Australia who have or are at high risk for atherothrombotic disease. The perspective was a governmental one, at the federal level for pharmaceuticals and at the state level for hospitalizations.
One-year follow-up data were obtained for Australian participants in the international REACH (Reduction of Atherothrombosis for Continued Health) Registry who were aged >or=45 years and had either established atherothrombotic disease (coronary artery disease, cerebrovascular disease, or peripheral artery disease [PAD]) or >or=3 risk factors for atherothrombotic disease. Information was extracted on the use of cardiovascular medications, hospitalizations, general practice visits, clinical pathology and imaging studies, and use of rehabilitation services. Bottom-up costing was undertaken by assigning unit costs to each health care item, based on Australian government reimbursement data for 2006-2007. Costs were estimated in Australian dollars.
Data for 2873 Australian participants in the REACH Registry were included in the analysis. Mean (SD) annual pharmaceutical costs per person were A$1388 (A$645). Mean ambulatory care costs per person were A$704 (A$492), and mean hospitalization costs were A$10,711 (A$10,494). Compared with participants with >or=3 risk factors (adjusted for age and sex), participants with 2 to 3 affected vascular territories incurred A$160 more in mean pharmaceutical costs (95% CI, 78 to 256) and A$181 more in ambulatory care costs (95% CI, 107 to 252). Mean ambulatory care costs were A$132 greater among participants with PAD only relative to those with >or=3 risk factors (95% CI, 19 to 272). Hospital costs were not significantly increased with an increasing number of affected vascular territories. The greatest difference in direct hospital costs (A$943) was between participants with PAD relative to those with >or=3 risk factors (95% CI, -564 to 3545).
From the government perspective, management of atherothrombotic disease in Australia was costly during the period studied, particularly among those with PAD only or disease affecting 2 to 3 vascular territories. Hospitalization accounted for the majority of health care expenditure associated with atherothrombotic disease, although the number of hospitalized participants was relatively small.
在大多数国家，动脉粥样硬化血栓形成疾病的治疗管理占直接医疗费用的很大比例，给医疗保健支付者带来了巨大的经济负担。关于使用“自下而上”方法计算个人直接医疗费用的知识有限。
本研究旨在估计澳大利亚社区人群的个人直接医疗费用，这些人群患有或有发生动脉粥样硬化血栓形成疾病的高风险。本研究从政府角度出发，以联邦政府的药品和州政府的住院治疗为视角。
对参加国际 REACH（持续健康的抗动脉粥样硬化血栓形成）登记研究的澳大利亚参与者进行为期 1 年的随访，这些参与者年龄≥45 岁，并且有以下情况之一：已确诊动脉粥样硬化血栓形成疾病（冠状动脉疾病、脑血管疾病或外周动脉疾病[PAD]），或有≥3 个动脉粥样硬化血栓形成疾病风险因素。研究人员提取了心血管药物使用、住院、全科医生就诊、临床病理学和影像学研究以及康复服务使用等信息。根据 2006-2007 年澳大利亚政府报销数据，对每个医疗保健项目进行单位成本赋值，从而进行自下而上的成本核算。费用以澳元计。
REACH 登记研究的 2873 名澳大利亚参与者的数据纳入了分析。每人每年的平均（SD）药品费用为 1388 澳元（645 澳元）。每人每年的平均门诊护理费用为 704 澳元（492 澳元），平均住院费用为 10711 澳元（10494 澳元）。与有≥3 个风险因素的参与者（按年龄和性别调整）相比，有 2 至 3 个受影响的血管区域的参与者的药品费用平均多支出 160 澳元（95%CI，78 至 256），门诊护理费用多支出 181 澳元（95%CI，107 至 252）。与有≥3 个风险因素的参与者相比，仅患有 PAD 的参与者的门诊护理费用平均多支出 132 澳元（95%CI，19 至 272）。随着受影响的血管区域数量的增加，住院费用并没有显著增加。直接住院费用的最大差异为 943 澳元，与有 PAD 的参与者相比，有≥3 个风险因素的参与者的费用减少了 564 澳元（95%CI，-564 至 3545）。
从政府的角度来看，在研究期间，澳大利亚动脉粥样硬化血栓形成疾病的治疗管理费用较高，特别是对于仅患有 PAD 或疾病影响 2 至 3 个血管区域的患者。尽管住院患者人数相对较少，但住院治疗仍是与动脉粥样硬化血栓形成疾病相关的医疗保健支出的主要部分。
