评估痛风患者的医疗保健费用和使用模式。

Evaluation of health care costs and utilization patterns for patients with gout.

机构信息

Health Outcomes and Pharmacy Practice Division, The University of Texas College of Pharmacy, Austin, Texas, USA.

出版信息

Clin Ther. 2012 Mar;34(3):640-52. doi: 10.1016/j.clinthera.2012.01.020. Epub 2012 Mar 3.

DOI:10.1016/j.clinthera.2012.01.020

PMID:22381710

Abstract

BACKGROUND

The prevalence of gout has been increasing. Serum uric acid (sUA) levels ≥6 mg/dL have been associated with high morbidity and increased health care utilization.

OBJECTIVE

To assess the costs and patterns of health care resource utilization for patients with gout, categorized into 3 cohorts based on sUA levels.

METHODS

We retrospectively analyzed laboratory, pharmacy, and medical service claims data (January 2005 to June 2010) for patients ≥18 years old. Inclusion criteria were at least 2 sUA levels and at least 1 primary gout diagnosis (International Classification of Disease-9th revision code 274.xx), and/or at least 1 prescription for gout-specific medications. Outcomes including costs, health care resource utilization, and medication adherence and persistence were assessed for the 1-year postindex period and summarized for the 3 cohorts based on sUA levels: <6 mg/dL, 6 to 8.99 mg/dL, and ≥9 mg/dL. Costs were adjusted based on preindex utilization and baseline characteristics.

RESULTS

Three hundred fifty-two patients met the inclusion criteria: cohort 1 (sUA <6 mg/dL), n = 38, mean age 59 years; cohort 2 (sUA 6-8.99 mg/dL), n = 231, mean age 61 years; and cohort 3 (sUA ≥9 mg/dL), n = 83, mean age 62 years. Mean adjusted gout-related health care costs were $332, $353, and $663, respectively (P <0.05); mean adjusted all-cause health care costs were $11,365, $11,551, and $14,474, respectively, for the 3 cohorts (P <0.05). sUA levels were positively associated with the percent of patients who had at least 1 hospitalization and the mean number of hospitalizations and emergency department visits (P < 0.05). Significantly more patients with sUA <6 mg/dL achieved adherence rates of ≥80% and had a longer mean duration of continuous treatment compared with patients with sUA between 6 and 8.99 mg/dL or ≥9.0 mg/dL (P <0.05).

CONCLUSIONS

Patients with high levels of sUA had higher gout-related and all-cause health care costs, more all-cause hospitalizations, and emergency department visits, but they also exhibited poorer adherence and persistence.

摘要

背景

痛风的患病率一直在上升。血清尿酸（sUA）水平≥6mg/dL 与高发病率和增加的医疗保健利用率相关。

目的

根据 sUA 水平将痛风患者分为 3 个队列，评估痛风患者的医疗保健资源利用的成本和模式。

方法

我们回顾性分析了实验室、药房和医疗服务索赔数据（2005 年 1 月至 2010 年 6 月），纳入标准为至少 2 次 sUA 水平和至少 1 次原发性痛风诊断（国际疾病分类第 9 版代码 274.xx），和/或至少 1 次痛风特异性药物处方。在索引后 1 年内评估了成本、医疗保健资源利用以及药物依从性和持久性等结局，并根据 sUA 水平对 3 个队列进行总结：<6mg/dL、6-8.99mg/dL 和≥9mg/dL。根据索引前的利用情况和基线特征对成本进行了调整。

结果

共有 352 名患者符合纳入标准：队列 1（sUA<6mg/dL），n=38，平均年龄 59 岁；队列 2（sUA 6-8.99mg/dL），n=231，平均年龄 61 岁；队列 3（sUA≥9mg/dL），n=83，平均年龄 62 岁。调整后的痛风相关医疗保健费用分别为 332 美元、353 美元和 663 美元（P<0.05）；调整后的全因医疗保健费用分别为 11365 美元、11551 美元和 14474 美元，3 个队列之间差异均有统计学意义（P<0.05）。sUA 水平与至少有 1 次住院和平均住院次数和急诊就诊次数的患者百分比呈正相关（P<0.05）。与 sUA 水平在 6-8.99mg/dL 或≥9.0mg/dL 之间的患者相比，sUA<6mg/dL 的患者达到≥80%的依从率的比例更高，且持续治疗的平均时间更长（P<0.05）。