Campbell Jennifer A, Bishu Kinfe G, Walker Rebekah J, Egede Leonard E
Center for Patient Care and Outcomes Research, Medical College of Wisconsin, 8701 Watertown Plank Road, Room H3165, Milwaukee, WI 53226, USA.
Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI 53226, USA.
Health Qual Life Outcomes. 2017 Apr 13;15(1):70. doi: 10.1186/s12955-017-0651-7.
Studies indicate a relationship between cost and quality of life (QOL) in diabetes care, however, the interaction is complex and the relationship is not well understood. The aim of this study was to 1) examine the relationship of quartiles of QOL on cost amongst U.S. adults with diabetes, 2) investigate how the relationship may change over time, and 3) examine the incremental effect of QOL on cost while controlling for other relevant covariates.
Data from 2002-2011 Medical Expenditure Panel Survey (MEPS) was used to examine the association between QOL and medical expenditures among adults with diabetes (aged ≥18 years) N = 20,442. Unadjusted means were computed to compare total healthcare expenditure and the out-of-pocket expenses by QOL quartile categories. QOL measures were Physical Component Summary (PCS) and Mental Component Summary (MCS) derived from the Short-Form 12. A two-part model was then used to estimate adjusted incremental total healthcare expenditure and out-of-pocket expenses adjusting for relevant covariates.
Differences between the highest and lowest quartiles totaled $11,801 for total expenditures and $989 for out-of-pocket expenses. Over time, total expenditures remained stable, while out-of-pocket expenses decreased, particularly for the lowest quartile of physical component of QOL. Similar trends were seen in the mental component, however, differences between quartiles were smaller (average $5,727 in total expenses; $287 in out-of-pocket). After adjusting for covariates, those in the highest quartile of physical component of QOL spent $7,500 less, and those in the highest quartile of mental component spent $3,000 less than those in the lowest quartiles.
A clear gradient between QOL and cost with increasing physical and mental QOL associated with lower expenditures and out-of-pocket expenses was found. Over a 10-year time period those with the highest physical QOL had significantly less medical expenditures compared to those with the lowest physical QOL. This study demonstrates the significant individual and societal impact poor QOL has on patients with diabetes. Understanding how differences in a subjective measure of health, such as QOL, has on healthcare expenditures helps reveal the burden of disease not reflected by using only behavioral and physiological measures.
研究表明糖尿病护理的成本与生活质量（QOL）之间存在关联，然而，这种相互作用很复杂，其关系尚未得到充分理解。本研究的目的是：1）研究美国成年糖尿病患者生活质量四分位数与成本之间的关系；2）调查这种关系如何随时间变化；3）在控制其他相关协变量的同时，研究生活质量对成本的增量影响。
使用2002 - 2011年医疗支出面板调查（MEPS）的数据，研究成年糖尿病患者（年龄≥18岁，N = 20442）的生活质量与医疗支出之间的关联。计算未调整均值，以比较按生活质量四分位数分类的总医疗支出和自付费用。生活质量指标采用从简式健康调查问卷12中得出的身体成分总结（PCS）和心理成分总结（MCS）。然后使用两部分模型来估计调整后的总医疗支出增量和自付费用，并对相关协变量进行调整。
最高和最低四分位数之间的总支出差异为11801美元，自付费用差异为989美元。随着时间推移，总支出保持稳定，而自付费用下降，特别是生活质量身体成分最低四分位数的患者。心理成分也出现类似趋势，不过四分位数之间的差异较小（总费用平均为5727美元；自付费用为287美元）。在调整协变量后，生活质量身体成分最高四分位数的患者比最低四分位数的患者少花费7500美元，心理成分最高四分位数的患者比最低四分位数的患者少花费3000美元。
发现生活质量与成本之间存在明显梯度，身体和心理生活质量提高与较低的支出和自付费用相关。在10年期间，身体生活质量最高的患者与最低的患者相比，医疗支出显著更少。本研究表明生活质量差对糖尿病患者有重大的个人和社会影响。了解诸如生活质量这样的主观健康指标差异如何影响医疗支出，有助于揭示仅使用行为和生理指标未反映出的疾病负担。
