Echouffo-Tcheugui Justin B, Bishu Kinfe G, Fonarow Gregg C, Egede Leonard E
Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
Center for Health Disparities Research, Division of General Internal Medicine, Medical University of South Carolina, Charleston, SC; Department of Medicine, Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, Charleston, SC.
Am Heart J. 2017 Apr;186:63-72. doi: 10.1016/j.ahj.2017.01.003. Epub 2017 Jan 13.
Population-based national data on the trends in expenditures related to heart failure (HF) are scarce. Assessing the time trends in health care expenditures for HF in the United States can help to better define the burden of this condition.
Using 10-year data (2002-2011) from the national Medical Expenditure Panel Survey (weighted sample of 188,708,194US adults aged ≥18years) and a 2-part model (adjusting for demographics, comorbidities, and time); we estimated adjusted mean and incremental medical expenditures by HF status. The costs were direct total health care expenditures (out-of-pocket payments and payments by private insurance, Medicaid, Medicare, and other sources) from various sources (office-based visits, hospital outpatient, emergency department, inpatient hospital, pharmacy, home health care, and other medical expenditures).
Compared with expenditures for individuals without HF ($5511 [95% CI 5405-5617]), individuals with HF had a 4-fold higher mean expenditures of ($23,854 [95% CI 21,733-25,975]). Individuals with HF had $3446 (95% CI 2592-4299) higher direct incremental expenditures compared with those without HF, after adjusting for demographics and comorbidities. Among those with HF, costs continuously increased by $5836 (28% relative increase), from $21,316 (95% CI 18,359-24,272) in 2002/2003 to $27,152 (95% CI 20,066-34,237) in 2010/2011, and inpatient costs ($11,318 over the whole period) were the single largest component of total medical expenditure. The estimated unadjusted total direct medical expenditures for US adults with HF were $30 billion/y and the adjusted total incremental expenditure was $5.8 billion/y.
Heart failure is costly and over a recent 10-year period, and direct expenditure related to HF increased markedly, mainly driven by inpatient costs.
基于人群的有关心力衰竭（HF）支出趋势的全国性数据稀缺。评估美国HF医疗保健支出的时间趋势有助于更好地界定这种疾病的负担。
使用来自国家医疗支出小组调查的10年数据（2002 - 2011年，加权样本为188,708,194名年龄≥18岁的美国成年人）以及两部分模型（针对人口统计学、合并症和时间进行调整）；我们按HF状态估计了调整后的平均医疗支出和增量医疗支出。成本为来自各种来源（门诊就诊、医院门诊、急诊科、住院医院、药房、家庭医疗保健和其他医疗支出）的直接医疗总支出（自付费用以及私人保险、医疗补助、医疗保险和其他来源的支付）。
与无HF个体的支出（5511美元[95%置信区间5405 - 5617]）相比，HF个体的平均支出高出4倍（23,854美元[95%置信区间21,733 - 25,975]）。在调整人口统计学和合并症后，与无HF个体相比，HF个体的直接增量支出高出3446美元（95%置信区间2592 - 4299）。在患有HF的人群中，成本持续增加5836美元（相对增加28%），从2002/2003年的21,316美元（95%置信区间18,359 - 24,272）增至2010/2011年的27,152美元（95%置信区间20,066 - 34,237），住院成本（整个期间为11,318美元）是医疗总支出的最大单一组成部分。估计美国患有HF的成年人未经调整的直接医疗总支出为每年300亿美元，调整后的总增量支出为每年58亿美元。
心力衰竭成本高昂，在最近10年期间，与HF相关的直接支出显著增加，主要由住院成本推动。
