Cappell Katherine A, Shreay Sanatan, Cao Zhun, Varker Helen V, Paoli Carly J, Gitlin Matthew
Truven Health Analytics, 777 East Eisenhower Parkway, Ann Arbor, MI 48108, USA.
BMC Nephrol. 2014 Jul 11;15:116. doi: 10.1186/1471-2369-15-116.
Several major ESRD-related regulatory and reimbursement changes were introduced in the United States in 2011. In several large, national datasets, these changes have been associated with decreases in erythropoiesis stimulating agent (ESA) utilization and hemoglobin concentrations in the ESRD population, as well as an increase in the use of red blood cell (RBC) transfusions in this population. Our objective was to examine the use of RBC transfusion before and after the regulatory and reimbursement changes implemented in 2011 in a prevalent population of chronic dialysis patients in a large national claims database.
Patients in the Truven Health MarketScan Commercial and Medicare Databases with evidence of chronic dialysis were selected for the study. The proportion of chronic dialysis patients who received any RBC transfusion and RBC transfusion event rates per 100 patient-months were calculated in each month from January 1, 2007 to March 31, 2012. The results were analyzed overall and stratified by primary health insurance payer (commercial payer or Medicare).
Overall, the percent of chronic dialysis patients with RBC transfusion and RBC transfusion event rates per 100 patient-months increased between January 2007 and March 2012. When stratified by primary health insurance payer, it appears that the increase was driven by the primary Medicare insurance population. While the percent of patients with RBC transfusion and RBC transfusion event rates did not increase in the commercially insured population between 2007 and 2012 they did increase in the primary Medicare insurance population; the majority of the increase occurred in 2011 during the same time frame as the ESRD-related regulatory and reimbursement changes.
The regulatory and reimbursement changes implemented in 2011 may have contributed to an increase in the use of RBC transfusions in chronic dialysis patients in the MarketScan dataset who were covered by Medicare plus Medicare supplemental insurance.
2011年美国出台了几项与终末期肾病（ESRD）相关的重大监管和报销政策变化。在几个大型全国性数据集中，这些变化与ESRD人群中促红细胞生成素（ESA）使用量和血红蛋白浓度的下降有关，同时该人群中红细胞（RBC）输注的使用量有所增加。我们的目标是在一个大型全国性索赔数据库中，研究2011年实施监管和报销政策变化前后，慢性透析患者普遍人群中RBC输注的使用情况。
从Truven Health MarketScan商业和医疗保险数据库中选择有慢性透析证据的患者进行研究。计算2007年1月1日至2012年3月31日每个月接受任何RBC输注的慢性透析患者比例以及每100患者月的RBC输注事件发生率。结果进行了总体分析，并按主要医疗保险支付方（商业支付方或医疗保险）进行分层。
总体而言，2007年1月至2012年3月期间，接受RBC输注的慢性透析患者百分比和每100患者月的RBC输注事件发生率有所增加。按主要医疗保险支付方分层时，似乎这种增加是由主要医疗保险人群推动的。虽然2007年至2012年期间商业保险人群中接受RBC输注的患者百分比和RBC输注事件发生率没有增加，但主要医疗保险人群中确实有所增加；大部分增加发生在2011年，与ESRD相关的监管和报销政策变化处于同一时间段。
2叭1年实施的监管和报销政策变化可能导致MarketScan数据集中由医疗保险加医疗保险补充保险覆盖的慢性透析患者中RBC输注的使用增加。
