College of Pharmacy, Purdue University, West Lafayette, Indiana 47907-2091, USA.
Am J Geriatr Psychiatry. 2012 Jan;20(1):73-83. doi: 10.1097/JGP.0b013e318209dce4.
With the growing number of older adults, understanding expenditures associated with treating medical conditions that are more prevalent among older adults is increasingly important. The objectives of this research were to estimate incremental medical encounters and incremental Medicaid expenditures associated with dementia among Indiana Medicaid recipients 40 years or older in 2004.
A retrospective cohort design analyzing Indiana Medicaid administrative claims files was used. Individuals at least 40 years of age with Indiana Medicaid eligibility during 2004 were included. Patients with dementia were identified via diagnosis codes in claims files between July 2001 and December 2004. Adjusted annual incremental medical encounters and expenditures associated with dementia in 2004 were estimated using negative binomial regression and zero-inflated negative binomial regression models.
A total of 18,950 individuals (13%) with dementia were identified from 145,684 who were 40 years or older. The unadjusted mean total annualized Medicaid expenditures for the cohort with dementia ($28,758) were significantly higher than the mean expenditures for the cohort without dementia ($14,609). After adjusting for covariates, Indiana Medicaid incurred annualized incremental expenditures of $9,829 per recipient with dementia. Much of the annual incremental expenditure associated with dementia was driven by the higher number of days in nursing homes and resulting nursing-home expenditures. Drug expenditures accounted for the second largest component of the incremental expenditures. On the basis of disease prevalence and per recipient annualized incremental expenditures, projected incremental annualized Indiana Medicaid spending associated with dementia for persons 40 or more years of age was $186 million.
Dementia is associated with significant expenditures among Medicaid recipients. Disease management initiatives designed to reduce nursing-home use among recipients with dementia may have much potential to decrease Medicaid expenditures associated with dementia.
随着老年人口的增加，了解治疗老年人中更为常见的医疗状况相关的支出变得越来越重要。本研究的目的是估计 2004 年印第安纳州医疗补助计划（Medicaid）中 40 岁及以上患者中痴呆症相关的增量医疗就诊次数和增量医疗补助支出。
采用回顾性队列设计，分析印第安纳州医疗补助管理索赔文件。纳入在 2004 年期间有资格获得印第安纳州医疗补助的至少 40 岁的患者。通过索赔文件中的诊断代码在 2001 年 7 月至 2004 年 12 月期间确定痴呆症患者。使用负二项回归和零膨胀负二项回归模型来估计 2004 年与痴呆症相关的调整后年度增量医疗就诊次数和支出。
在 145684 名 40 岁及以上的患者中，共确定了 18950 名（13%）痴呆症患者。患有痴呆症的队列的未经调整的年化平均医疗补助支出总额（$28758）明显高于没有痴呆症的队列的平均支出（$14609）。调整了协变量后，印第安纳州医疗补助计划为每位患有痴呆症的患者每年增加了$9829 的支出。与痴呆症相关的年度增量支出的大部分是由于疗养院的天数增加以及由此产生的疗养院支出。药物支出占增量支出的第二大组成部分。基于疾病流行率和每位患者年化增量支出，预计印第安纳州 40 岁及以上患者与痴呆症相关的增量年化支出为$1.86 亿美元。
痴呆症与医疗补助计划受助者的支出显著相关。旨在减少痴呆症患者入住疗养院的疾病管理计划可能有很大潜力降低与痴呆症相关的医疗补助支出。
