Lin Junji, Zhang Xinke, Li Xiaoyan, Chandler David, Altomare Ivy, Wasser Jeffrey S, Cetin Karynsa
Amgen Inc, Thousand Oaks, California.
Amgen Inc, Thousand Oaks, California; University of Southern California, Los Angeles, California.
Clin Ther. 2017 Mar;39(3):603-609.e1. doi: 10.1016/j.clinthera.2017.01.023. Epub 2017 Feb 9.
We estimated the real-world costs of bleeding-related episodes (BREs) in adults with primary immune thrombocytopenia (ITP).
This retrospective cohort study used the MarketScan Commercial Claims and Encounters and Medicare Supplemental and Coordination of Benefits databases. We identified adult patients diagnosed with primary ITP between 2007 and 2012, defined by at least 2 outpatient claims separated by ≥30 days or 1 inpatient claim (International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code for primary ITP [287.31]). BRE was defined according to a combination of diagnosis codes and/or procedure codes indicating bleeding or use of rescue therapies. Costs were estimated using total reimbursed amount received by providers (including out-of-pocket costs and reimbursement from insurance, adjusted to 2015 US dollars).
In 6551 patients, 14,115 BREs were identified, mean (SD) age was 55 (18) years, and 62% of patients were women. Mean total reimbursement per BRE was $6022, with significantly higher mean inpatient ($45,114) versus outpatient ($2150) reimbursements (P < 0.0001). Mean BRE reimbursements were higher in splenectomized patients compared with nonsplenectomized patients ($8365 vs $5858); however, the difference was not statistically significant. Mean reimbursement for BREs associated with bleeding alone was $10,396, and with rescue therapy alone it was $2787. Reimbursement for BREs that included both bleeding and rescue therapy was $11,065.
The real-world reimbursement rates of BREs in adult patients with primary ITP can be substantial, with significantly higher values among patients requiring hospitalization and for those with bleeding events. Additionally, there is a trend toward higher reimbursement rates among splenectomized patients.
我们估算了成人原发性免疫性血小板减少症（ITP）患者出血相关事件（BRE）的实际成本。
这项回顾性队列研究使用了MarketScan商业索赔与病历数据库以及医疗保险补充和福利协调数据库。我们确定了2007年至2012年间被诊断为原发性ITP的成年患者，定义为至少有2次间隔≥30天的门诊索赔或1次住院索赔（国际疾病分类第九版临床修订本中原发性ITP的诊断代码[287.31]）。BRE根据表明出血或使用抢救治疗的诊断代码和/或程序代码组合来定义。成本使用提供者收到的总报销金额估算（包括自付费用和保险报销，调整为2015年美元）。
在6551名患者中，共识别出14115次BRE，平均（标准差）年龄为55（18）岁，62%的患者为女性。每次BRE的平均总报销额为6022美元，住院患者的平均报销额（45114美元）显著高于门诊患者（2150美元）（P<0.0001）。脾切除患者的BRE平均报销额高于未行脾切除的患者（8365美元对5858美元）；然而，差异无统计学意义。仅与出血相关的BRE平均报销额为10396美元，仅与抢救治疗相关的BRE平均报销额为2787美元。包括出血和抢救治疗的BRE报销额为11065美元。
成人原发性ITP患者BRE的实际报销率可能很高，在需要住院的患者以及发生出血事件的患者中报销率显著更高。此外，脾切除患者的报销率有升高趋势。
