Collard Harold R, Chen Shih-Yin, Yeh Wei-Shi, Li Qian, Lee Yuan-Chi, Wang Alan, Raghu Ganesh
1 University of California San Francisco, School of Medicine, San Francisco, California.
2 Biogen, Health Economics and Outcomes Research, Global Market Access, Cambridge, and.
Ann Am Thorac Soc. 2015 Jul;12(7):981-7. doi: 10.1513/AnnalsATS.201412-553OC.
Management of idiopathic pulmonary fibrosis (IPF) is resource-intensive. Because an increasing prevalence of IPF was found among the elderly in the United States, it is important to understand the economic burden associated with the disease in this population.
To compare health care resource utilization and costs between patients with IPF and matched control subjects without IPF in Medicare, the largest U.S. payer covering the elderly.
Administrative claims from a 5% random sample of Medicare beneficiaries (aged 65+) from years 2000 to 2011 were analyzed. Incident patients with IPF were identified on the basis of International Classification of Diseases, ninth revision, Clinical Modification diagnosis codes, with at least 1 year of enrollment before (preindex) and after (postindex) the first diagnosis (index date). Up to five beneficiaries without IPF were matched to each patient with IPF, based on age, sex, race, and region. Annual health care resource utilization and medical costs (excluding outpatient drug costs) during the preindex and postindex periods were compared between patients with IPF and matched control subjects.
A total of 7,855 patients with IPF were matched to 38,856 control subjects. Compared with matched control subjects during the preindex period, patients with IPF had an 82% higher risk of hospitalization (28.8 vs. 15.8%), and 72% higher total medical costs ($10,124 vs. $5,888). Compared with matched control subjects during the postindex period, patients with IPF had a 134% higher risk of hospitalization (48.7 vs. 20.8%), similar increased risk of emergency room visits (39.6 vs. 17.5%), and 134% higher total medical costs ($20,887 vs. $8,932).
In the U.S. Medicare population, patients with IPF incurred substantial health care resource utilization. The annual IPF-attributable medical cost to the U.S. health care system, excluding medication costs, is estimated at close to $2 billion.
特发性肺纤维化（IPF）的管理需要大量资源。由于在美国老年人中发现IPF的患病率不断上升，了解该疾病在这一人群中所带来的经济负担很重要。
比较美国最大的老年医保支付方医疗保险中IPF患者与匹配的非IPF对照受试者之间的医疗资源利用情况和费用。
分析了2000年至2011年医疗保险受益人（65岁及以上）5%随机样本的行政索赔数据。根据国际疾病分类第九版临床修订本诊断代码确定IPF确诊患者，在首次诊断（索引日期）之前（索引前）和之后（索引后）至少有1年的参保时间。根据年龄、性别、种族和地区，为每位IPF患者匹配多达5名非IPF受益人。比较了IPF患者与匹配的对照受试者在索引前和索引后期间的年度医疗资源利用情况和医疗费用（不包括门诊药品费用）。
共7855例IPF患者与38856名对照受试者匹配。与索引前期间的匹配对照受试者相比，IPF患者住院风险高82%（28.8%对15.8%），总医疗费用高72%（10124美元对5888美元）。与索引后期间的匹配对照受试者相比，IPF患者住院风险高134%（48.7%对20.8%），急诊就诊风险增加相似（39.6%对17.5%），总医疗费用高134%（20887美元对8932美元）。
在美国医疗保险人群中，IPF患者产生了大量医疗资源利用。美国医疗保健系统每年因IPF产生的医疗费用（不包括药物费用）估计接近20亿美元。
