Armstrong April W, Zhao Yang, Herrera Vivian, Li Yunfeng, Bancroft Tim, Hull Michael, Altan Aylin
a University of Southern California , Los Angeles , CA , USA.
b Health Economics and Outcomes Research , Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA.
J Dermatolog Treat. 2017 Nov;28(7):613-622. doi: 10.1080/09546634.2017.1303566. Epub 2017 Mar 20.
To examine characteristics, healthcare utilization and costs among patients with psoriasis who have high medical costs.
This is a retrospective study of patients with psoriasis with continuous enrollment from 1 January 2011 to 31 December 2013 in a large US health plan. Total paid 2012 healthcare costs excluding biologics (to identify costliest not due to biologic costs) were used to create cohorts representing the top 10% (T10) and bottom 90% (B90) of expenditures. Demographics, comorbidities, prescriptions, all-cause and psoriasis-related healthcare utilization and costs were compared between cohorts. Logistic regression identified demographic and clinical characteristics associated with the 2012 T10 cohort status.
18,653 patients (mean age 48 years; 49% female) were included. Patients in the T10 group accounted for 26% (2011), 39% (2012) and 26% (2013) of all-cause costs including biologics and 13% (2011), 18% (2012) and 11% (2013) of psoriasis-related costs. Mean 2012 total costs were $58,030 for T10 vs. $10,295 for B90 (all-cause) and $10,475 vs. $5301 (psoriasis-related). T10 patients in 2012 filled more prescriptions and were more likely to use corticosteroids (57% vs. 31%); however, biologic use and costs were similar (any use: 23% vs. 24%; prescriptions: 1.5 vs. 1.7, biologic costs: $4959 vs. $5095). Compared with B90 patients, T10 patients were more likely to have hospitalizations (all-cause: 45% vs. 3%; psoriasis-related: 14% vs. 1%) and ER visits (all-cause: 53% vs. 21%; psoriasis-related: 3% vs. 1%), and more likely to have renal disease (odds ratio (OR) = 2.05), depression (OR =1.96), cardiovascular disease (OR =1.88), psoriatic arthritis (OR =1.57) and diabetes (OR =1.50) (all p < .05).
The T10 patient cohort in 2012 accounted for nearly 40% of overall healthcare expenditures. However, cost differences between the T10 and B90 patients were not attributable to psoriasis-related biologic treatment utilization and costs. The T10 patients had significantly more inpatient and emergency utilization, and comorbid medical conditions.
研究医疗费用高昂的银屑病患者的特征、医疗服务利用情况及费用。
这是一项回顾性研究，研究对象为2011年1月1日至2013年12月31日期间连续参保于美国一项大型健康计划的银屑病患者。使用2012年不包括生物制剂的总支付医疗费用（以确定非生物制剂费用导致的最高费用）来创建代表支出前10%（T10）和后90%（B90）的队列。比较队列之间的人口统计学、合并症、处方、全因及银屑病相关的医疗服务利用情况和费用。逻辑回归确定与2012年T10队列状态相关的人口统计学和临床特征。
纳入了18,653名患者（平均年龄48岁；49%为女性）。T10组患者占包括生物制剂在内的全因费用的26%（2011年）、39%（2012年）和26%（2013年），以及银屑病相关费用的13%（2011年）、18%（2012年）和11%（2013年）。2012年T10组的平均总费用为58,030美元，而B90组为10,295美元（全因），银屑病相关费用分别为10,475美元和5301美元。2012年T10组患者开具的处方更多，且更有可能使用皮质类固醇（57%对31%）；然而，生物制剂的使用和费用相似（任何使用情况：23%对24%；处方：1.5对1.7，生物制剂费用：4959美元对5095美元）。与B90组患者相比，T10组患者更有可能住院（全因：45%对3%；银屑病相关：14%对1%）和急诊就诊（全因：53%对2%；银屑病相关：3%对1%），并且更有可能患有肾病（比值比（OR）=2.05）、抑郁症（OR =1.96）、心血管疾病（OR =1.88）、银屑病关节炎（OR =1.57）和糖尿病（OR =1.50）（所有p<0.05）。
2012年T10患者队列占总体医疗支出的近40%。然而，T10和B90患者之间的费用差异并非归因于银屑病相关生物制剂治疗的使用和费用。T10患者的住院和急诊利用率以及合并症明显更多。
