Kaiser Permanente Center for Health Research, 3800 N. Interstate Avenue, Portland, OR 97227-1098, USA.
J Clin Lipidol. 2012 Sep-Oct;6(5):443-9. doi: 10.1016/j.jacl.2012.03.002. Epub 2012 Mar 23.
Severe hypertriglyceridemia is associated with resource-intensive conditions such as cardiovascular disease, diabetes, and pancreatitis. Whether triglyceride (TG) reduction reduces annual medical costs has not been studied.
The objective was to compare medical care costs after changes in triglyceride levels for up to 5 years of follow-up.
Using an observational cohort, we identified 808 individuals who had a baseline TG level ≥500 mg/dL in calendar year 2004 and had a second measure 6 to 24 weeks later. We collected all subsequent inpatient, outpatient, and pharmacy use and medical cost data through 2009. Percentage change from baseline TG level was used to create six categories: decreased ≥60%, 45%-59%, 30%-44%, 15%-29%, 0%-14%, and TG increase. We estimated and compared annualized medical care costs by adjusting for baseline costs, baseline TG, high-density lipoprotein, and low-density lipoprotein cholesterol levels, age, sex, smoking status, body mass index, blood pressure, and presence of comorbidities such as diabetes and cardiovascular disease.
Mean age of the cohort was 55.9 ± 11.7 years and 66% were men. Patients who reduced their TG levels by ≥60% experienced a mean annualized reduction from baseline medical costs of $471, whereas costs increased in all other TG change categories. Between-group differences were most pronounced in the first three years, but none were statistically significant.
This observational study was unable to establish that TG lowering among patients with severe hypertriglyceridemia produced statistically significantly lower hospital use or medical care costs. However, the nonsignificant trends observed suggest that a larger study conducted with controlled TG lowering may be warranted.
严重的高甘油三酯血症与心血管疾病、糖尿病和胰腺炎等资源密集型疾病相关。降低甘油三酯(TG)是否会降低年度医疗费用尚未得到研究。
本研究旨在比较高达 5 年随访期间 TG 水平变化后的医疗保健费用。
使用观察性队列,我们确定了 808 名在 2004 年日历年基线 TG 水平≥500mg/dL 且在之后 6 至 24 周内有第二次测量的个体。我们收集了所有后续的住院、门诊和药房使用以及医疗成本数据,直至 2009 年。使用基线 TG 水平的百分比变化创建了六个类别:降低≥60%、45%-59%、30%-44%、15%-29%、0%-14%和 TG 增加。我们通过调整基线成本、基线 TG、高密度脂蛋白和低密度脂蛋白胆固醇水平、年龄、性别、吸烟状况、体重指数、血压以及合并症(如糖尿病和心血管疾病)的存在,估计并比较了年化医疗保健费用。
队列的平均年龄为 55.9±11.7 岁,66%为男性。TG 水平降低≥60%的患者的基线医疗成本年化降低了 471 美元,而其他所有 TG 变化类别的成本都有所增加。在最初的三年内,组间差异最为明显,但均无统计学意义。
本观察性研究无法确定严重高甘油三酯血症患者降低 TG 是否会导致住院使用或医疗保健费用在统计学上显著降低。然而,观察到的非显著趋势表明,可能需要进行更大规模的、受控制的 TG 降低研究。