美国一项医保计划中最昂贵的银屑病患者三年内医疗费用的驱动因素
Drivers of Healthcare Costs Among the Costliest Patients With Psoriasis Over Three Years in a United States Health Plan.
作者信息
Armstrong April W, Zhao Yang, Herrera Vivian, Li Yunfeng, Bancroft Tim, Hull Michael, Altan Aylin
出版信息
J Drugs Dermatol. 2017 Jul 1;16(7):651-658.
OBJECTIVE: To compare patients with psoriasis by cost level over 3 years.
METHODS: Psoriasis patients in a large US health plan in 2011-2013 were identified. Four groups were created by healthcare costs excluding biologics: patients having top 10% of costs in all 3 years (Top), top 10% in 2 of 3 years (High), bottom 90% in 2 of 3 years (Medium), and bottom 90% in all 3 years (Bottom). Comorbidities, utilization, and costs between groups were compared.
RESULTS: The study included 18,653 patients: 514 (3%), 805 (4%), 2,443 (13%), and 14,891 (80%) patients in the Top, High, Medium, and Bottom groups, respectively. Significantly more patients in the Top vs Bottom group had diabetes (31.1% vs 9.4%), cardiovascular disease (26.5% vs 4.3%), psoriatic arthritis (25.7% vs 10.7%), depression (27.8% vs 6.9%), and anxiety (22.0% vs 7.9%) in 2011 (all P less than 0.05). Patients in the Top group had more unique 2011 prescriptions (17.7 vs 6.6; P less than 0.001) than the Bottom group, but similar biologic use (22.4% vs 21.6%). Patients in the Top, High, Medium, and Bottom groups had mean 2011 total costs of $68,913, $40,575, $24,292, and $8,815, and contributed to 14%, 13%, 23%, and 51% of the overall costs, respectively. Mean total costs increased 14-18% over time for all groups. Although mean 2011 total costs for patients in the Top group were 7.8 times of those in the Bottom group, psoriasis-related costs were less disparate ($8,716 vs $4,541). Compared with patients in the Bottom group, those in the Top group were more likely to have any 2011 hospitalization (36.8% vs 2.6%; psoriasis-related: 11.1% vs 0.7%) or emergency visit (50.8% vs 20.8%; psoriasis-related: 3.9% vs 1.0%).
CONCLUSION: The costliest patients with psoriasis had significantly higher prevalence of comorbidities, prescription fills, inpatient and emergency utilization, but not biologic medication use or biologic costs.
J Drugs Dermatol. 2017;16(7):651-658.
.目的
按3年的费用水平比较银屑病患者。
方法
确定2011 - 2013年美国一个大型健康计划中的银屑病患者。根据不包括生物制剂的医疗费用创建四组：在所有3年中费用处于前10%的患者（高费用组），在3年中的2年费用处于前10%的患者（较高费用组），在3年中的2年费用处于后90%的患者（中等费用组），以及在所有3年中费用处于后90%的患者（低费用组）。比较各组之间的合并症、医疗服务利用情况和费用。
结果
该研究纳入了18653例患者：高费用组、较高费用组、中等费用组和低费用组分别有514例（3%）、805例（4%）、2443例（13%）和14891例（80%）患者。与低费用组相比，高费用组在2011年有更多患者患有糖尿病（31.1%对9.4%）、心血管疾病（26.5%对4.3%）、银屑病关节炎（25.7%对10.7%）、抑郁症（27.8%对6.9%）和焦虑症（22.0%对7.9%）（所有P值均小于0.05）。高费用组患者在2011年的独特处方数（17.7对6.6；P值小于0.001）比低费用组多，但生物制剂使用情况相似（22.4%对21.6%）。高费用组、较高费用组、中等费用组和低费用组患者在2011年的平均总费用分别为68913美元、40575美元、24292美元和8815美元，分别占总费用的14%、13%、23%和51%。所有组的平均总费用随时间增加了14% - 18%。尽管高费用组患者2011年的平均总费用是低费用组患者的7.8倍，但银屑病相关费用的差距较小（8716美元对4541美元）。与低费用组患者相比，高费用组患者在2011年更有可能住院（36.8%对2.6%；银屑病相关住院：11.1%对0.7%）或急诊就诊（50.8%对20.8%；银屑病相关急诊：3.9%对1.0%）。
结论
费用最高的银屑病患者合并症、处方填充、住院和急诊利用的患病率显著更高，但生物制剂用药或生物制剂费用并非如此。
《皮肤药物学杂志》2017年；16(7):651 - 658。
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