IMS Health, Alexandria, VA, USA.
J Med Econ. 2013 Aug;16(8):1043-50. doi: 10.3111/13696998.2013.818545. Epub 2013 Jul 5.
This study quantified the direct healthcare costs and major cost drivers among patients with Huntington's disease (HD), by disease stage in commercial and Medicaid databases.
This retrospective database analysis used healthcare utilization/cost data for HD patients (ICD-9-CM 333.4) from Thomson Reuters' MarketScan Commercial and Medicaid 2002-2009 databases. Patients were classified by disease stage (Early/Middle/Late) by a hierarchical assessment of markers of disease severity, confirmed by literature review and key opinion leader input. Costs were measured over the follow-up time of each patient with total costs per patient per stage annualized using a patient-year cost approach.
Among 1272 HD patients, the mean age was similar in commercial (752 patients) and Medicaid (520 patients) populations (48.5 years (SD = 13.3) and 49.3 years (SD = 17.2), respectively). Commercial patients were evenly distributed by stage (30.5%/35.5%/34.0%; Early/Middle/Late). However, most (74.0%) Medicaid HD patients were classified as Late stage. The mean total annualized cost per patient increased by stage (commercial: $4947 (SD = $6040)-$22,582 (SD = $39,028); Medicaid: $3257 (SD = $5670)-$37,495 (SD = $27,111). Outpatient costs were the primary healthcare cost component. The vast majority (73.8%) of Medicaid Late stage patients received nursing home care and the majority (54.6%) of Medicaid Late stage costs were associated with nursing home care. In comparison, only 40.6% of commercial Late stage patients received nursing home care, which contributed to only 4.6% of commercial Late stage costs.
The annual direct economic burden of HD is substantial and increased with disease progression. More late stage Medicaid HD patients were in nursing homes and for a longer time than their commercial counterparts, reflected by their higher costs (suggesting greater disease severity). Key limitations include the classification of patients into a single stage, as well as a lack of visibility into full long-term care/nursing home-related costs for commercial patients.
本研究通过商业和医疗补助数据库，按疾病阶段量化亨廷顿病（HD）患者的直接医疗保健成本和主要成本驱动因素。
本回顾性数据库分析使用了来自汤姆森路透公司 MarketScan 商业和医疗补助 2002-2009 数据库中亨廷顿病患者（ICD-9-CM 333.4）的医疗保健利用/成本数据。根据文献综述和主要意见领袖的输入，通过对疾病严重程度标志物的分层评估，将患者分为疾病早期/中期/晚期阶段。采用患者年成本法，对每位患者的随访时间进行年化，以每位患者每个阶段的年度总成本来衡量成本。
在 1272 名亨廷顿病患者中，商业（752 名患者）和医疗补助（520 名患者）人群的平均年龄相似（分别为 48.5 岁（SD=13.3）和 49.3 岁（SD=17.2））。商业患者按阶段分布均匀（30.5%/35.5%/34.0%；早期/中期/晚期）。然而，大多数（74.0%）医疗补助 HD 患者被归类为晚期。每位患者的平均年化总成本随阶段而增加（商业：$4947（SD=$6040）-$22582（SD=$39028）；医疗补助：$3257（SD=$5670）-$37495（SD=$27111））。门诊费用是主要的医疗保健费用组成部分。绝大多数（73.8%）的医疗补助晚期患者接受了疗养院护理，大多数（54.6%）的医疗补助晚期成本与疗养院护理有关。相比之下，只有 40.6%的商业晚期患者接受了疗养院护理，这仅占商业晚期成本的 4.6%。
亨廷顿病的直接经济负担是巨大的，并且随着疾病的进展而增加。与商业患者相比，更多的医疗补助晚期 HD 患者在疗养院中停留的时间更长，这反映在他们更高的成本上（表明疾病严重程度更高）。主要限制包括将患者分为单一阶段，以及缺乏对商业患者的全面长期护理/疗养院相关成本的了解。
