高成本 2 型糖尿病患者：管理式医疗管理数据分析。
The high-cost, type 2 diabetes mellitus patient: an analysis of managed care administrative data.
机构信息
RTI Health Solutions, 200 Park Offices Drive, Research Triangle Park, NC 27709, USA.
AstraZeneca, 1800 Concord Pike, Wilmington, DE 19850, USA.
出版信息
Arch Public Health. 2014 Feb 27;72(1):6. doi: 10.1186/2049-3258-72-6.
BACKGROUND
Type 2 diabetes mellitus (T2DM) affects 25.8 million individuals in the United States and exerts a substantial economic burden on patients, health care systems, and society. Few studies have categorized costs and resource use at the patient level. The goals of this study were to assess predictors of being a high-cost (HC) patient and compare HC T2DM patients with not high-cost (NHC) T2DM patients.
METHODS
Using managed care administrative claims data, patients with two or more T2DM diagnoses between 2005 and 2010 were selected. Patients were followed for 1 year after their first observed T2DM diagnosis; patients not continuously enrolled during this period were excluded from the study. Study measures included annual health care expenditures by component (i.e., inpatient, outpatient, pharmacy, total). Patients accruing total costs in the top 10% of the overall cost distribution (i.e., patients with costs > $20,528) were classified as HC a priori; all other patients were considered NHC. To assess predictors of being HC, a logistic regression model was estimated, accounting for demographics; underlying comorbidity burden (using the Charlson Comorbidity Index [CCI] score); diagnoses of renal impairment, obesity, or hypertension; and receipt of insulin, oral antidiabetics only, or no antidiabetics.
RESULTS
A total of 1,720,041 patients met the inclusion criteria; 172,004 were HC. The mean (SD) CCI score for HC patients was 4.3 (3.0) versus 2.1 (1.7) for NHC patients. Mean (SD; upper 95% confidence interval-lower 95% confidence interval) annual per-patient costs were $56,468 ($65,604; $56,778-$56,157) among HC patients and $4,674 ($4,504; $4,695-$4,652) among NHC patients. Inpatient care and pharmacy costs were higher for HC patients than for NHC patients. The strongest predictor of being an HC patient was having a CCI score of 2 or greater (odds ratio [OR] = 4.896), followed by a diagnosis of obesity (OR = 2.106), renal impairment (OR = 2.368), and insulin use (OR = 2.098).
CONCLUSIONS
High-cost T2DM patients accrue approximately $52,000 more in total annual health care costs than not high-cost T2DM patients. Patients were significantly more likely to be high-cost if they had comorbid conditions, a diagnosis of obesity, or used insulin.
背景
2 型糖尿病（T2DM）影响了美国 2580 万人，给患者、医疗保健系统和社会带来了巨大的经济负担。很少有研究对患者层面的成本和资源使用进行分类。本研究的目的是评估成为高成本（HC）患者的预测因素，并比较 HC T2DM 患者和非高成本（NHC）T2DM 患者。
方法
使用管理式医疗保健行政索赔数据，选择 2005 年至 2010 年间有两个或更多 T2DM 诊断的患者。在他们首次观察到 T2DM 诊断后的 1 年内对患者进行随访；在此期间未连续入组的患者被排除在研究之外。研究措施包括按组成部分（即住院、门诊、药房、总费用）计算的年度医疗保健支出。根据总成本分布的前 10%（即费用超过$20528 的患者），预先将总费用归入 HC；所有其他患者均被视为 NHC。为了评估成为 HC 的预测因素，我们使用逻辑回归模型进行了估计，该模型考虑了人口统计学因素、潜在合并症负担（使用 Charlson 合并症指数[CCI]评分）、肾功能损害、肥胖或高血压的诊断以及胰岛素、口服抗糖尿病药物或无抗糖尿病药物的使用情况。
结果
共有 1720041 名患者符合纳入标准；其中 172004 名患者为 HC。HC 患者的平均（SD）CCI 评分为 4.3（3.0），而非 HC 患者的平均（SD）CCI 评分为 2.1（1.7）。HC 患者的人均年治疗费用（平均值[SD]；上 95%置信区间-下 95%置信区间）为$56468（$65604；$56778-$56157），而非 HC 患者的人均年治疗费用为$4674（$4504；$4695-$4502）。HC 患者的住院治疗和药房费用高于 NHC 患者。成为 HC 患者的最强预测因素是 CCI 评分为 2 或更高（优势比[OR] = 4.896），其次是肥胖症诊断（OR = 2.106）、肾功能损害（OR = 2.368）和胰岛素使用（OR = 2.098）。
结论
高成本 T2DM 患者的年度总医疗保健费用比非高成本 T2DM 患者高出约$52000。如果患者有合并症、肥胖症或使用胰岛素，他们成为高成本患者的可能性显著增加。
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