Kirby Joslyn S, Gregory Tanner, Liu Guodong, Leslie Douglas L, Miller Jeffrey J
Department of Dermatology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania.
Penn State College of Medicine, Hershey, Pennsylvania.
JAMA Dermatol. 2017 Apr 1;153(4):264-269. doi: 10.1001/jamadermatol.2016.4733.
Actinic keratosis (AK), a skin growth induced by ultraviolet light exposure, requires chronic management because a small proportion can progress into squamous cell skin cancer. Spending for AK management was more than $1 billion in 2004. Investigating geographic variation in AK spending presents an opportunity to decrease waste or recoup excess spending.
To evaluate geographic variation in health care cost for management of AKs and the association with patient-related and health-related factors.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study was performed using data from the MarketScan medical claims database of 488 324 continuously enrolled members with 2 or more claims for AK. Data from January 1, 2008, to December 31, 2012, was used.
Annual costs of care were calculated for outpatient visits, AK destruction, and medications for AKs, and the total of these components. Costs were adjusted for inflation to 2014 US dollars. To display cost variation, we calculated the ratio of mean cost in the highest quintile (Q5) relative to the mean in the lowest quintile (Q1), or the Q5:Q1 ratio; Q5:Q1 ratios were adjusted based on age, sex, history of nonmelanoma skin cancer, US geographic region, and population density (metropolitan statistical area).
Overall, data from 488 324 continuously enrolled members (mean [SD] age, 53.1 [7.5] years; 243 662 women) with 2 or more claims for AK were included. Overall, patients had 1 085 985 claims related to AK, and dermatologists accounted for 71.0% of claims. The 2-year total cost was $111.5 million, with $52.4 million in 2011 and $59.1 million in 2012. The unadjusted Q5:Q1 ratios for total annual cost per patient ranged from 9.49 to 15.10. Adjusted ratios ranged from 1.72 to 1.80.
There is variation in AK management cost within and between regions. This is not fully explained by differences in patient characteristics such as age, sex, or comorbidities. The annual cost for 10 common conditions from Medicare had lower Q5:Q1 ratios that ranged from 1.33 (joint degeneration of back/neck) to 1.69 (chronic sinusitis) when compared with 1.72 to 1.80 for AKs. This suggests an opportunity to investigate and improve the value of health care delivery in the management of AKs.
光化性角化病（AK）是一种因紫外线照射引起的皮肤病变，由于一小部分可能会发展为皮肤鳞状细胞癌，因此需要长期管理。2004年，用于AK管理的支出超过10亿美元。研究AK支出的地理差异为减少浪费或收回超额支出提供了契机。
评估AK管理的医疗保健成本的地理差异以及与患者相关因素和健康相关因素的关联。
设计、设置和参与者：这项回顾性队列研究使用了MarketScan医疗索赔数据库中的数据，该数据库包含488324名连续参保且有2次或更多次AK索赔记录的成员。使用的数据来自2008年1月1日至2012年12月31日。
计算门诊就诊、AK破坏治疗以及AK用药的年度护理成本，以及这些组成部分的总和。成本已根据通货膨胀调整为2014年美元。为了展示成本差异，我们计算了最高五分位数（Q5）的平均成本与最低五分位数（Q1）的平均成本之比，即Q5:Q1比率；Q5:Q1比率根据年龄、性别、非黑色素瘤皮肤癌病史、美国地理区域和人口密度（大都市统计区）进行了调整。
总体而言，纳入了488324名连续参保且有2次或更多次AK索赔记录的成员的数据（平均[标准差]年龄为53.1[7.5]岁；女性243662名）。总体而言，患者有1085985次与AK相关的索赔，皮肤科医生处理的索赔占71.0%。两年的总成本为1.115亿美元，其中2011年为5240万美元，2012年为5910万美元。每位患者每年总费用的未调整Q5:Q1比率在9.49至15.10之间。调整后的比率在1.72至1.80之间。
各地区内部和之间的AK管理成本存在差异。年龄、性别或合并症等患者特征的差异并不能完全解释这种现象。与AK的1.72至1.80相比，医疗保险中10种常见疾病的年度成本的Q5:Q1比率较低，范围从1.33（背部/颈部关节退变）到1.69（慢性鼻窦炎）。这表明有机会研究并提高AK管理中医疗保健服务的价值。
