Koster Matthew J, Achenbach Sara J, Crowson Cynthia S, Maradit-Kremers Hilal, Matteson Eric L, Warrington Kenneth J
From the Department of Internal Medicine, Division of Rheumatology; Department of Health Sciences Research, Division of Biomedical Statistics and Informatics; Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic, Rochester, Minnesota, USA.
M.J. Koster, MD, Department of Internal Medicine, Division of Rheumatology, Mayo Clinic; S.J. Achenbach, MS, Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic; C.S. Crowson, MS, Department of Internal Medicine, Division of Rheumatology, and Department of Health Sciences Research, Division of Biomedical Statistics and Informatics, Mayo Clinic; H. Maradit-Kremers, MD, MSc, Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic; E.L. Matteson, MD, MPH, Department of Internal Medicine, Division of Rheumatology, and Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic; K.J. Warrington, MD, Department of Internal Medicine, Division of Rheumatology, Mayo Clinic.
J Rheumatol. 2017 Jul;44(7):1044-1050. doi: 10.3899/jrheum.161516. Epub 2017 May 1.
To determine the healthcare use and direct medical cost of giant cell arteritis (GCA) in a population-based cohort.
A well-defined, retrospective population-based cohort of Olmsted County, Minnesota, USA, residents diagnosed with GCA from 1982-2009 was compared to a matched referent cohort from the same population. Standardized cost data (inflation-adjusted to 2014 US dollars) for 1987-2014 and outpatient use data for 1995-2014 were obtained. Use and costs were compared between cohorts through signed-rank paired tests, McNemar's tests, and quantile regression models.
Significant annual differences in outpatient costs were observed for patients with GCA in each of the first 4 years (median differences: $2085, $437, $382, $388, respectively). In adjusted analyses, median incremental cost attributed to GCA over a 5-year period was $4662. Compared with matched referent subjects, patients with GCA had higher use of laboratory visit-days annually for each of the first 3 years following incidence/index date, and increased outpatient physician visits for years 0-1, 1-2, and 3-4. Patients with GCA had significantly more radiology visit-days in years 0-1, 3-4, and 4-5, and more ophthalmologic procedures/surgery in years 0-1, 1-2, 2-3, and 4-5 compared to non-GCA. Emergency medicine visits, musculoskeletal, and cardiovascular procedures/surgery were similar between GCA and non-GCA groups throughout the study period.
Direct medical outpatient costs were increased in the month preceding and in the first 4 years following GCA diagnosis. Higher use of outpatient physician, laboratory, and radiology visits, and ophthalmologic procedures among these patients accounts for the increased cost of care.
确定基于人群队列中巨细胞动脉炎（GCA）的医疗保健利用情况和直接医疗费用。
将美国明尼苏达州奥尔姆斯特德县1982年至2009年确诊为GCA的明确、基于人群的回顾性队列与来自同一人群的匹配对照队列进行比较。获取了1987年至2014年的标准化成本数据（按2014年美元进行通胀调整）以及1995年至2014年的门诊使用数据。通过符号秩配对检验、麦克尼马尔检验和分位数回归模型比较队列之间的使用情况和成本。
在最初4年中，每年GCA患者的门诊费用均存在显著差异（中位数差异分别为：2085美元、437美元、382美元、388美元）。在调整分析中，5年期间归因于GCA的中位数增量成本为4662美元。与匹配的对照对象相比，GCA患者在发病/索引日期后的前3年中每年的实验室就诊天数使用量更高，在0 - 1年、1 - 2年和3 - 4年的门诊医生就诊次数增加。与非GCA患者相比，GCA患者在0 - 1年、3 - 4年和4 - 5年的放射科就诊天数显著更多，在0 - 1年、1 - 2年、2 - 3年和4 - 5年的眼科手术/操作更多。在整个研究期间，GCA组和非GCA组之间的急诊就诊、肌肉骨骼和心血管手术/操作相似。
GCA诊断前一个月及诊断后的前4年，直接医疗门诊费用增加。这些患者门诊医生、实验室和放射科就诊以及眼科手术的使用量增加导致了护理成本的增加。
