LaMori Joyce, Tandon Neeta, Laliberté François, Germain Guillaume, Pilon Dominic, Lefebvre Patrick, Prabhakar Avinash
a a Janssen Scientific Affairs , LLC , Titusville , NJ , USA.
b b Groupe d'analyse , Ltée , Montréal , QC , Canada.
J Med Econ. 2016;19(4):364-73. doi: 10.3111/13696998.2015.1127252. Epub 2016 Jan 11.
Since hepatitis C virus therapy is typically prioritized for patients with more advanced disease, predicting which patients will progress could help direct scarce resources to those likely to benefit most. This study aims to identify demographics and clinical characteristics associated with high healthcare resource utilization (HRU) and liver disease progression among CHC patients.
Using health insurance claims (January 2001-March 2013), adult patients with ≥2 CHC claims (ICD-9-CM: 070.44 or 070.54), and ≥6 months of continuous insurance coverage before and ≥36 months after the first CHC diagnosis were included. Patients with human immunodeficiency virus were excluded. Generalized estimating equations were used to identify the demographic and clinical characteristics of being in the 20% of patients with the highest HRU. Factors predicting liver disease progression were also identified.
In the study population (n = 4898), liver disease severity and both CHC- and non-CHC-related comorbidities and conditions were strong predictors of high healthcare costs, with odds ratios (ORs; 95% confidence interval [CI]) for ≥2 CHC-related and ≥2 non-CHC-related comorbidities/conditions of 2.78 (2.48-3.12) and 2.19 (1.76-2.72), respectively. CHC- and non-CHC-related comorbidities and conditions were also strong predictors of liver disease progression with ORs (95% CI) for ≥2 CHC-related and ≥2 non-CHC-related comorbidities and conditions of 2.18 (1.83-2.60) and 1.50 (1.14-1.97), respectively.
Potential inaccuracies in claims data, information or classification bias, and findings based on a privately insured population.
This study suggests that CHC patients with high healthcare resource utilization have a high level of comorbidity at baseline and also that non-CHC comorbidities and conditions are strong predictors of high HRU. Non-cirrhotic CHC patients with one or more comorbidities are at high risk of progressing to cirrhosis or end-stage liver disease.
由于丙型肝炎病毒治疗通常优先用于病情更严重的患者，预测哪些患者会病情进展有助于将稀缺资源导向可能最受益的患者。本研究旨在确定与丙型肝炎患者高医疗资源利用（HRU）和肝病进展相关的人口统计学和临床特征。
利用医疗保险理赔数据（2001年1月至2013年3月），纳入有≥2次丙型肝炎理赔记录（国际疾病分类第九版临床修订本：070.44或070.54）、首次丙型肝炎诊断前连续参保≥6个月且诊断后连续参保≥36个月的成年患者。排除感染人类免疫缺陷病毒的患者。采用广义估计方程确定HRU最高的20%患者的人口统计学和临床特征。还确定了预测肝病进展的因素。
在研究人群（n = 4898）中，肝病严重程度以及丙型肝炎相关和非丙型肝炎相关的合并症及病症都是高医疗费用的有力预测因素，≥2种丙型肝炎相关合并症及病症和≥2种非丙型肝炎相关合并症及病症的优势比（OR；95%置信区间[CI]）分别为2.78（2.48 - 3.12）和2.19（1.76 - 2.72）。丙型肝炎相关和非丙型肝炎相关的合并症及病症也是肝病进展的有力预测因素，≥2种丙型肝炎相关合并症及病症和≥2种非丙型肝炎相关合并症及病症的OR（95%CI）分别为2.18（1.83 - 2.60）和1.50（1.14 - 1.97）。
理赔数据可能存在不准确之处、信息或分类偏差，且研究结果基于私人参保人群。
本研究表明，医疗资源利用高的丙型肝炎患者在基线时合并症水平较高，而且非丙型肝炎合并症及病症是高HRU的有力预测因素。患有一种或多种合并症的非肝硬化丙型肝炎患者进展为肝硬化或终末期肝病的风险很高。
