Ecogene-21 Clinical Research Center and Department of Medicine, Université de Montréal, Montreal, Canada.
J Med Econ. 2013;16(5):657-66. doi: 10.3111/13696998.2013.779277. Epub 2013 Mar 11.
The prevalence of severe hypertriglyceridemia (TG > 1000 mg/dl) is estimated at 150-400 per 100,000 individuals in North America. Severe hypertriglyceridemia in the fasting state is associated with increased acute pancreatitis risk and is a sign of chylomicronemia which reflects the accumulation in the bloodstream of chylomicrons, the large lipoprotein particles produced in the gut after a meal.
To assess medical resource use and costs associated with chylomicronemia.
Patients with chylomicronemia of different causes (≥2 diagnoses with ICD-9 code 272.3) were identified from a large US claims database (years 2000 to 2009) and matched 1:1 to controls free of chylomicronemia based on age, gender, demographics, comorbidities, and use of lipid lowering drugs. During a 1-year study period, medical resource use and costs associated with chylomicronemia or acute pancreatitis were compared between matched cases and controls.
Among 6472 matched pairs, annual per-patient medical costs, calculated independently of the occurrence of acute pancreatitis, were significantly greater by $808 for chylomicronemia cases vs controls ($8029 vs $7220, p < 0.01), half of which was attributable to chylomicronemia-related services (p < 0.01). Chylomicronemia cases with a history of acute pancreatitis (n = 46) had greater rates of inpatient visits (p < 0.05) and greater average costs for subsequent acute pancreatitis or abdominal pain (p < 0.01) as well as greater total medical costs ($33,587 vs $4402, p < 0.01) vs matched controls. The average episode of acute pancreatitis (n = 104 episodes) generated medical costs of $31,820, almost entirely due to inpatient stays.
Triglyceride levels were not available to characterize disease severity.
Patients with chylomicronemia, and especially those with a history of acute pancreatitis, incurred significantly greater total medical costs compared with individuals without chylomicronemia but with an otherwise comparable health profile.
据估计，北美的严重高甘油三酯血症（TG>1000mg/dl）患病率为每 10 万人中有 150-400 例。空腹时的严重高甘油三酯血症与急性胰腺炎风险增加有关，是乳糜微粒血症的标志，反映了餐后肠道中乳糜微粒（大量脂蛋白颗粒）在血液中的积累。
评估与乳糜微粒血症相关的医疗资源使用和成本。
从一个大型美国索赔数据库（2000 年至 2009 年）中确定了不同病因的乳糜微粒血症患者（≥2 次 ICD-9 代码 272.3 诊断），并根据年龄、性别、人口统计学、合并症和降脂药物使用情况，与无乳糜微粒血症的对照者 1:1 匹配。在为期 1 年的研究期间，比较了匹配病例和对照者之间与乳糜微粒血症或急性胰腺炎相关的医疗资源使用和成本。
在 6472 对匹配的患者中，无论是否发生急性胰腺炎，乳糜微粒血症患者的年度人均医疗费用比对照组高出 808 美元（8029 美元 vs 7220 美元，p<0.01），其中一半归因于乳糜微粒血症相关服务（p<0.01）。有急性胰腺炎病史的乳糜微粒血症患者（n=46）的住院率更高（p<0.05），随后急性胰腺炎或腹痛的平均费用更高（p<0.01），总医疗费用也更高（33587 美元 vs 4402 美元，p<0.01），与匹配的对照组相比。104 例急性胰腺炎发作的平均费用为 31820 美元，几乎全部归因于住院治疗。
无法获得甘油三酯水平来描述疾病严重程度。
与没有乳糜微粒血症但具有相似健康状况的个体相比，乳糜微粒血症患者，尤其是有急性胰腺炎病史的患者，总医疗费用显著增加。
