Rice J Bradford, White Alan, Lopez Andrea, Conway Alexandra, Wagh Aneesha, Nelson Winnie W, Philbin Michael, Wan George J
a Analysis Group, Inc. , Boston , MA USA.
b Mallinckrodt Pharmaceuticals, Inc., Health Economics & Outcomes Research , Hampton , NJ , USA.
J Med Econ. 2017 Oct;20(10):1048-1055. doi: 10.1080/13696998.2017.1351371. Epub 2017 Jul 21.
Sarcoidosis is a multi-system inflammatory disorder characterized by the presence of non-caseating granulomas in involved organs. Patients with sarcoidosis have a reduced quality-of-life and are at an increased risk for several comorbidities. Little is known about the direct and indirect cost of sarcoidosis following the initial diagnosis.
To provide an estimate of the healthcare resource utilization (HCRU) and costs borne by commercial payers for sarcoidosis patients in the US.
Patients with a first diagnosis of sarcoidosis between January 1, 1998 and March 31, 2015 ("index date") were selected from a de-identified privately-insured administrative claims database. Sarcoidosis patients were required to have continuous health plan enrollment 12 months prior to and following their index dates. Propensity-score (1:1) matching of sarcoidosis patients with non-sarcoidosis controls was carried out based on a logistic regression of baseline characteristics. Burden of HCRU and work loss (disability days and medically-related absenteeism) were compared between the matched groups over the 12-month period following the index date ("outcome period").
A total of 7,119 sarcoidosis patients who met the selection criteria were matched with a control. Overall, commercial payers incurred $19,714 in mean total annual healthcare costs per sarcoidosis patient. The principle cost drivers were outpatient visits ($9,050 2015 USD, 46%) and inpatient admissions ($6,398, 32%). Relative to controls, sarcoidosis patients had $5,190 (36%) higher total healthcare costs ($19,714 vs $14,524; p < 0.001). Sarcoidosis patients also had significantly more work loss days (15.9 vs 11.3; p < 0.001) and work loss costs ($3,288 vs $2,527; p < 0.001) than matched controls. Sarcoidosis imposes an estimated total direct medical cost of $1.3-$8.7 billion to commercial payers, and an indirect cost of $0.2-$1.5 billion to commercial payers in work loss.
Sarcoidosis imposes a significant economic burden to payers in the first year following diagnosis.
结节病是一种多系统炎症性疾病，其特征是受累器官中存在非干酪样肉芽肿。结节病患者的生活质量下降，患几种合并症的风险增加。对于结节病初诊后的直接和间接成本知之甚少。
估计美国商业医保支付方为结节病患者承担的医疗资源利用（HCRU）和成本。
从一个经过去识别处理的私人医保行政理赔数据库中选取1998年1月1日至2015年3月31日期间首次诊断为结节病的患者（“索引日期”）。结节病患者在索引日期之前和之后需连续参保12个月。基于基线特征的逻辑回归，对结节病患者与非结节病对照进行倾向得分（1:1）匹配。在索引日期之后的12个月期间（“结果期”），比较匹配组之间的HCRU负担和工作损失（残疾天数和与医疗相关的缺勤）。
共有7119名符合选择标准的结节病患者与一名对照进行了匹配。总体而言，商业医保支付方为每名结节病患者平均每年承担19714美元的医疗总费用。主要成本驱动因素是门诊就诊（2015年9050美元，占46%）和住院（6398美元，占32%）。与对照组相比，结节病患者的医疗总费用高出5190美元（36%）（19714美元对14524美元；p<0.001）。结节病患者的工作损失天数（15.9天对11.3天；p<0.001）和工作损失成本（3288美元对2527美元；p<0.001）也显著高于匹配的对照组。结节病给商业医保支付方带来的估计总直接医疗成本为13亿至87亿美元，工作损失方面的间接成本为2亿至15亿美元。
结节病在诊断后的第一年给医保支付方带来了巨大的经济负担。
