高钾血症给医疗保险和商业医保支付方带来的临床及经济负担
The Clinical and Economic Burden of Hyperkalemia on Medicare and Commercial Payers.
作者信息
Fitch Kathryn, Woolley J Michael, Engel Tyler, Blumen Helen
机构信息
Principal, Milliman, New York, NY.
Executive Director, ZS Pharma, San Mateo, CA.
出版信息
Am Health Drug Benefits. 2017 Jun;10(4):202-210.
BACKGROUND
Hyperkalemia (serum potassium >5.0 mEq/L) may be caused by reduced kidney function and drugs affecting the renin-angiotensin-aldosterone system and is often present in patients with chronic kidney disease (CKD).
OBJECTIVE
To quantify the burden of hyperkalemia in US Medicare fee-for-service and commercially insured populations using real-world claims data, focusing on prevalence, comorbidities, mortality, medical utilization, and cost.
METHODS
A descriptive, retrospective claims data analysis was performed on patients with hyperkalemia using the 2014 Medicare 5% sample and the 2014 Truven Health Analytics MarketScan Commercial Claims and Encounter databases. The starting study samples required patient insurance eligibility during ≥1 months in 2014. The identification of hyperkalemia and other comorbidities required having ≥1 qualifying claims in 2014 with an appropriate diagnosis code in any position. To address the differences between patients with and without hyperkalemia, CKD subsamples were analyzed separately. Mortality rates were calculated in the Medicare sample population only. The claims were grouped into major service categories; the allowed costs reflected all costs incurred by each cohort divided by the total number of member months for that cohort.
RESULTS
The prevalence of hyperkalemia in the Medicare and commercially insured samples was 2.3% and 0.09%, respectively. Hyperkalemia was associated with multiple comorbidities, most notably CKD. The prevalence of CKD in the Medicare and the commercially insured members with hyperkalemia was 64.8% and 31.8%, respectively. After adjusting for CKD severity, the annual mortality rate for Medicare patients with CKD and hyperkalemia was 24.9% versus 10.4% in patients with CKD without hyperkalemia. The allowed costs in patients with CKD and hyperkalemia in the Medicare and commercially insured cohorts were more than twice those in patients with CKD without hyperkalemia. Inpatient care accounted for >50% of costs in patients with CKD and hyperkalemia.
CONCLUSION
Hyperkalemia is associated with substantial clinical and economic burden among US commercially insured and Medicare populations.
背景
高钾血症（血清钾>5.0 mEq/L）可能由肾功能减退以及影响肾素-血管紧张素-醛固酮系统的药物引起，且常存在于慢性肾脏病（CKD）患者中。
目的
利用真实世界索赔数据，对美国医疗保险按服务付费人群和商业保险人群中高钾血症的负担进行量化，重点关注患病率、合并症、死亡率、医疗利用情况和成本。
方法
使用2014年医疗保险5%样本以及2014年Truven Health Analytics市场扫描商业索赔和病历数据库，对高钾血症患者进行描述性回顾性索赔数据分析。起始研究样本要求患者在2014年至少有1个月的保险资格。高钾血症和其他合并症的识别要求在2014年有≥1条符合条件的索赔，且在任何位置有适当的诊断代码。为解决有和没有高钾血症患者之间的差异，对CKD亚样本进行单独分析。仅在医疗保险样本人群中计算死亡率。索赔被分为主要服务类别；允许成本反映每个队列产生的所有成本除以该队列的成员月总数。
结果
医疗保险样本和商业保险样本中高钾血症的患病率分别为2.3%和0.09%。高钾血症与多种合并症相关，最显著的是CKD。医疗保险和患有高钾血症的商业保险成员中CKD的患病率分别为64.8%和31.8%。在调整CKD严重程度后，患有CKD和高钾血症的医疗保险患者的年死亡率为24.9%，而没有高钾血症的CKD患者为10.4%。医疗保险和商业保险队列中患有CKD和高钾血症患者的允许成本是没有高钾血症的CKD患者的两倍多。住院护理占患有CKD和高钾血症患者成本的>50%。
结论
在美国商业保险和医疗保险人群中，高钾血症与巨大的临床和经济负担相关。
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