Eli Lilly and Company, Indianapolis, IN 46285, USA.
J Med Econ. 2010;13(4):748-59. doi: 10.3111/13696998.2010.535661. Epub 2010 Nov 24.
This study compared differences in healthcare costs and resource utilization for acute coronary syndrome (ACS) patients with and without diabetes mellitus (DM).
A retrospective cohort study of a large, US employer-based claims database identified adults hospitalized for ACS between 01/01/2005 and 12/31/2006 and categorized them based on DM status. Resource utilization and costs during the index hospitalization and in the 12-month follow-up period were compared for ACS patients with and without DM using the propensity score stratification bootstrapping method, adjusting for differences in demographic and clinical characteristics.
Of 12,502 patients who met selection criteria, 3,040 (24%) had a history of DM and 9,462 (76%) did not. Patients with DM were older, female, and had higher rates of previous cardiovascular and renal diseases. After the propensity score stratification, patients with DM incurred higher index hospitalization costs ($32,577 vs. $29,150, p < 0.01) as well as higher total follow-up healthcare costs ($35,400 vs. $24,080, p < 0.01), including higher inpatient ($17,278 vs. $11,247, p < 0.01), outpatient ($12,357 vs. $8,853, p < 0.01), and pharmacy costs ($5,765 vs. $3,980, p < 0.01).
General limitations exist with any retrospective claims database analysis including potential diagnostic or procedural coding inaccuracies. Additionally, the patient population was representative of a working-age population with employer-sponsored health insurance and results may not be generalizable to other patient populations.
DM is significantly associated with increased healthcare resource utilization and costs for ACS patients.
本研究比较了伴或不伴糖尿病（DM）的急性冠状动脉综合征（ACS）患者的医疗成本和资源利用差异。
一项回顾性队列研究，对美国一个大型雇主保险理赔数据库中的 ACS 住院患者进行分析，根据 DM 状态进行分类。使用倾向评分分层bootstrap 方法，比较 DM 组和非 DM 组 ACS 患者在指数住院期间和 12 个月随访期间的资源利用和成本，同时调整了人口统计学和临床特征的差异。
符合入选标准的 12502 例患者中，3040 例（24%）有 DM 病史，9462 例（76%）无 DM 病史。DM 组患者年龄较大、女性比例较高，且既往心血管疾病和肾脏疾病的发生率较高。在倾向评分分层后，DM 组患者的指数住院费用更高（$32577 比 $29150，p<0.01），总随访医疗费用也更高（$35400 比 $24080，p<0.01），包括更高的住院费用（$17278 比 $11247，p<0.01）、门诊费用（$12357 比 $8853，p<0.01）和药物费用（$5765 比 $3980，p<0.01）。
任何回顾性理赔数据库分析都存在一般局限性，包括潜在的诊断或程序编码不准确。此外，患者人群代表了具有雇主赞助医疗保险的工作年龄人群，结果可能不适用于其他患者人群。
DM 与 ACS 患者的医疗资源利用和成本增加显著相关。
