Kiencke Peter, Rychlik Reinhard, Grimm Christine, Daniel Dietmar
Institut für Empirische Gesundheitsökonomie, Am Ziegelfeld 28, 51399, Burscheid, Germany.
Med Klin (Munich). 2010 May;105(5):327-33. doi: 10.1007/s00063-010-1060-4. Epub 2010 May 26.
The aim of this analysis was to generate cost data of provider services, drug acquisition, hospitalization, nursing care services, and adjuvants for patients with Alzheimer's disease, as well as to describe the distribution and development of care levels.
The analysis is based on anonymized data of patients with Alzheimer's disease who were insured by a large German statutory health insurance (Barmer Krankenkasse [BARMER]) in 2005 (n = 48,322). The study population was classified into three treatment groups: patients, who received memantine and no other antidementives, psychotropic drugs or hypnotics/sedatives (memantine group); patients who neither received memantine nor other antidementives, but psychotropic drugs and hypnotics/ sedatives (PHS group); and patients who received no antidementives or symptomatic therapy at all ("no dementia-specific AM"). Costs were fully assessed for patients in each treatment group and correlated with the care level.
In the memantine group, fewer patients needed care than in the other two groups. Total costs per patient averaged 7,028 Euros in the memantine group, 13,549 Euros in the PHS group, and 8,817 Euros in the group with no specific medication. Higher costs in the PHS group and in the group without drug treatment were mainly caused by a considerably higher rate of patients in need of care, of which nursing care made up the highest proportion. Fewer costs for medical treatment could not compensate the additional expenditures for nursing care. Patients in the PHS group had the highest average costs in all cost categories except for specific drug cost.
The results demonstrate that non-antidementive therapy for Alzheimer's disease causes higher costs especially in nursing care. The memantine group proved superior even though it had the highest costs in the specific drug category.
本分析旨在得出阿尔茨海默病患者的医疗服务、药品采购、住院治疗、护理服务及辅助治疗的成本数据,并描述护理水平的分布及发展情况。
该分析基于2005年由德国大型法定医疗保险机构(巴尔默健康保险股份公司[BARMER])承保的阿尔茨海默病患者的匿名数据(n = 48,322)。研究人群被分为三个治疗组:接受美金刚且未接受其他抗痴呆药、精神药物或催眠/镇静剂的患者(美金刚组);既未接受美金刚也未接受其他抗痴呆药,但接受精神药物和催眠/镇静剂的患者(PHS组);以及完全未接受抗痴呆药或对症治疗的患者(“无痴呆特异性治疗”组)。对每个治疗组的患者成本进行了全面评估,并与护理水平相关联。
美金刚组中需要护理的患者比其他两组少。美金刚组每位患者的总成本平均为7,028欧元,PHS组为13,549欧元,无特定药物治疗组为8,817欧元。PHS组和无药物治疗组成本较高主要是因为需要护理的患者比例大幅更高,其中护理费用占比最高。医疗费用降低无法弥补护理方面的额外支出。PHS组患者在除特定药物成本外的所有成本类别中平均成本最高。
结果表明,阿尔茨海默病的非抗痴呆治疗尤其是护理方面会导致更高成本。尽管美金刚组在特定药物类别中成本最高,但结果证明其更具优势。