Avalon Health Solutions, Inc., 1518 Walnut Steeet, Philadelphia, PA 19102, USA.
J Med Econ. 2011;14(4):497-507. doi: 10.3111/13696998.2011.594347. Epub 2011 Jun 20.
Comorbidities and resource utilization among patients with osteoarthritis (OA) in clinical practice have been infrequently characterized. The purpose of this study was to examine comorbidities, pain-related pharmacotherapy, and direct medical costs of patients with OA in clinical practice.
This retrospective cohort analysis used medical and pharmacy claims data from the LifeLink™ Database. OA patients (ICD-9-CM codes 715.XX) were matched (age, gender, and region) with individuals without OA. Comorbidities, pain-related pharmacotherapy, and direct medical costs (pharmacy, outpatient, inpatient, total) were examined for the calendar year 2008.
The sample consisted of 112,951 OA patients and 112,951 controls (mean age: 56.9 [SD=9.5] years; 62% female). Relative to controls, OA patients were significantly more likely (p<0.0001) to have comorbidities, including musculoskeletal (84.3 vs. 37.1%) and neuropathic pain (22.0 vs. 6.1%) conditions, depression (12.4 vs. 6.4%), anxiety (6.6 vs. 3.5%), and sleep disorders (11.9 vs. 4.2%). OA patients were significantly more likely (p<0.0001) to receive pain-related medications, including opioids (40.7 vs. 17.1%), NSAIDs (37.1 vs. 11.5%), tramadol (9.8 vs. 1.8%), and adjunctive medications for treating depression, anxiety, and insomnia. Mean [SD] total direct medical costs were more than two times higher among OA patients ($12,905 [$21,884] vs. $5099 [$13,855]; p<0.001) and median costs were more than three times higher ($6188 vs. $1879; p<0.0001). Study limitations include potential errors in coding and recording; overestimation of the comorbidity burden; inability to link condition of interest, OA, with prescribed medications; and possible underestimation of the true costs of OA, because indirect costs were not considered and the direct costs were from a third party payer (commercial insurance) perspective.
The patient burden of OA was characterized by a high prevalence of comorbidities. The payer burden was also substantial, with significantly greater use of pain-related and adjunctive medications, and higher direct medical costs.
临床实践中，骨关节炎（OA）患者的合并症和资源利用情况很少被描述。本研究的目的是研究 OA 患者的合并症、与疼痛相关的药物治疗以及临床实践中的直接医疗费用。
本回顾性队列分析使用了来自 LifeLink 数据库的医疗和药房索赔数据。OA 患者（ICD-9-CM 代码 715.XX）与没有 OA 的个体进行匹配（年龄、性别和地区）。2008 年对合并症、与疼痛相关的药物治疗以及直接医疗费用（药房、门诊、住院、总费用）进行了检查。
样本包括 112951 名 OA 患者和 112951 名对照（平均年龄：56.9[SD=9.5]岁；62%为女性）。与对照组相比，OA 患者更有可能（p<0.0001）出现合并症，包括肌肉骨骼（84.3%对 37.1%）和神经病理性疼痛（22.0%对 6.1%）、抑郁（12.4%对 6.4%）、焦虑（6.6%对 3.5%）和睡眠障碍（11.9%对 4.2%）。OA 患者更有可能（p<0.0001）接受与疼痛相关的药物治疗，包括阿片类药物（40.7%对 17.1%）、非甾体抗炎药（37.1%对 11.5%）、曲马多（9.8%对 1.8%）和治疗抑郁、焦虑和失眠的辅助药物。OA 患者的总直接医疗费用平均值[标准差]高出两倍以上（$12905 [$21884]对$5099 [$13855]；p<0.001），中位数费用高出三倍以上（$6188 对$1879；p<0.0001）。研究的局限性包括编码和记录中的潜在错误；合并症负担的高估；无法将感兴趣的疾病、OA 与处方药物联系起来；以及可能低估 OA 的实际成本，因为没有考虑间接成本，并且直接成本是从第三方支付者（商业保险）的角度考虑的。
OA 患者的患者负担特征是合并症高发。支付者的负担也很大，与疼痛相关的药物和辅助药物的使用显著增加，直接医疗费用也更高。
