Analysis Group, Inc., Boston, MA, USA.
Pharmacoeconomics. 2013 Sep;31(9):799-806. doi: 10.1007/s40273-013-0075-0.
This is the first analysis to estimate the costs of commercially insured patients with Parkinson's disease (PD) in the USA. Prior analyses of PD have not examined costs in patients aged under 65 years, a majority of whom are in the workforce.
Our objective was to estimate direct and indirect costs associated with PD in patients under the age of 65 years who are newly diagnosed or have evidence of advanced PD.
PD patients were selected from a commercially insured claims database (N > 12,000,000; 1999-2009); workloss data were available for a sub-sample of enrollees. Newly diagnosed patients with evidence of similar disorders were excluded. Patients with evidence of advanced PD disease, including ambulatory assistance device users (PDAAD) and institutionalized (PDINST) patients, as well as newly diagnosed PD patients, were analyzed. Each PD cohort was age-, gender- and region-matched to controls without PD. Direct (i.e. insurer payments to providers) and indirect (i.e. workloss) costs were reported in $US, year 2010 values, and were descriptively compared using Wilcoxon rank sum tests.
Patients had excess mean direct PD-related costs of $US4,072 (p < 0.001; N = 781) in the year after diagnosis. The PDAAD cohort (N = 214) had excess direct PD-related costs of $US26,467 (p < 0.001) and the PDINST cohort (N = 156) had excess direct PD-related costs of $US37,410 (p < 0.001) in the year after entering these states. Outpatient care was the most expensive cost source for newly diagnosed patients, while inpatient care was the most expensive for PDAAD and PDINST patients. Excess indirect costs were $US3,311 (p < 0.05; N = 173) in the year after initial diagnosis.
Direct costs for newly diagnosed PD patients exceeded costs for controls without PD, and increased with PD progression. Direct costs were approximately 6-7 times higher in patients with advanced PD than in matched controls. Indirect costs represented 45 % of total excess costs for newly diagnosed PD patients.
这是首次对美国商业保险的帕金森病（PD）患者进行成本分析。先前的 PD 分析并未对 65 岁以下患者的成本进行评估，而这一年龄段的大多数患者都在工作。
我们的目的是评估新诊断或已出现晚期 PD 证据的 65 岁以下 PD 患者的直接和间接成本。
从商业保险索赔数据库（N>1200 万；1999-2009 年）中选择 PD 患者；为参保人子样本提供了工作损失数据。排除有类似疾病证据的新诊断患者。分析了有证据表明患有晚期 PD 疾病的患者，包括使用助行器（PDAAD）和住院（PDINST）的患者，以及新诊断的 PD 患者。每个 PD 队列均按年龄、性别和地区与无 PD 的对照组相匹配。直接（即保险公司向提供者支付的款项）和间接（即工作损失）成本以 2010 年美元计价，并使用 Wilcoxon 秩和检验进行描述性比较。
诊断后第一年，患者的直接 PD 相关费用平均超出$4072（p<0.001；N=781）。PDAAD 队列（N=214）的直接 PD 相关费用超出$26467（p<0.001），PDINST 队列（N=156）的直接 PD 相关费用超出$37410（p<0.001）。新诊断患者的最昂贵费用来源是门诊护理，而 PDAAD 和 PDINST 患者的最昂贵费用来源是住院护理。初始诊断后一年，间接费用超出$3311（p<0.05；N=173）。
新诊断 PD 患者的直接费用超过无 PD 的对照组，且随着 PD 进展而增加。晚期 PD 患者的直接费用是匹配对照组的 6-7 倍。新诊断 PD 患者的间接费用占总超额费用的 45%。
