Menzin Joseph, Sussman Matthew, Munsell Michael, Zbrozek Arthur
Boston Health Economics, Inc., Waltham, MA, USA.
CSL Behring, LLC, King of Prussia, PA, USA.
Clinicoecon Outcomes Res. 2014 Jun 10;6:297-302. doi: 10.2147/CEOR.S63200. eCollection 2014.
There are limited data on the cost of infections among patients with primary immunodeficiency disease (PIDD) in clinical practice. The purpose of this study was to assess the economic impact, from the US commercial payer perspective, of infections in a cohort of patients with PIDD who were administered intravenous immunoglobulin (IVIG) therapy.
This study used administrative claims from the MarketScan(®) Database. Patients with a PIDD diagnosis, one or more prescription(s) for IVIG therapy between January 1, 2008 and February 28, 2010, and one or more prescription(s) for IVIG at least 3 months following first IVIG prescription, were selected. The study period consisted of a 7-month window following first IVIG prescription. Study measures included infection-related medical resource use and expenditures. Adjusted infection-related hospitalization expenditures were estimated using a generalized linear model, controlling for demographics, comorbidities, and infection type.
A total 1,742 patients with PIDD and consistent IVIG use were identified, with 490 patients (mean age 43; 58.8% female) having one or more infection(s) during the 7-month study period. Infection-related inpatient hospitalizations were the most expensive component of care (US$38,574 per hospitalized patient). In multivariate modeling, the presence of a blood infection during the hospitalization (versus [vs] no blood infection), having diabetes, and younger age (<18 vs 55-64) were associated with significant increases in infection-related hospitalization expenditures (49.3%, 55.3%, and 76.5%, respectively) (P<0.05).
Health care expenditures for infections in PIDD patients receiving IVIG therapy can be substantial, particularly for inpatient care. Future evaluations assessing the incremental cost of optimizing IVIG therapy should include evaluation of the effects on infection-related medical expenditures.
在临床实践中，关于原发性免疫缺陷病（PIDD）患者感染成本的数据有限。本研究的目的是从美国商业医保支付方的角度，评估接受静脉注射免疫球蛋白（IVIG）治疗的PIDD患者队列中感染的经济影响。
本研究使用了MarketScan®数据库中的管理索赔数据。选择了诊断为PIDD、在2008年1月1日至2010年2月28日期间有一张或多张IVIG治疗处方、且在首次IVIG处方后至少3个月有一张或多张IVIG处方的患者。研究期为首次IVIG处方后的7个月窗口期。研究指标包括与感染相关的医疗资源使用和支出。使用广义线性模型估计调整后的与感染相关的住院支出，并对人口统计学、合并症和感染类型进行控制。
共识别出1742例持续使用IVIG的PIDD患者，其中490例患者（平均年龄43岁；58.8%为女性）在7个月的研究期内发生了一次或多次感染。与感染相关的住院治疗是最昂贵的护理组成部分（每位住院患者38574美元）。在多变量建模中，住院期间发生血液感染（与无血液感染相比）、患有糖尿病以及年龄较小（<18岁与55 - 64岁相比）与感染相关住院支出的显著增加相关（分别为49.3%、55.3%和76.5%）（P<0.05）。
接受IVIG治疗的PIDD患者感染的医疗保健支出可能很高，尤其是住院护理方面。未来评估优化IVIG治疗增量成本的研究应包括对感染相关医疗支出影响的评估。
