阿尔茨海默病新诊断患者的经济负担、死亡率和住院率。

Economic Burden, Mortality, and Institutionalization in Patients Newly Diagnosed with Alzheimer's Disease.

机构信息

Merck & Co., Inc., Kenilworth, NJ, USA.

The Icahn School of Medicine at Mount Sinai, and the Alzheimer's Drug Discovery Foundation, New York, NY, USA.

出版信息

J Alzheimers Dis. 2018;61(1):185-193. doi: 10.3233/JAD-170518.

DOI:10.3233/JAD-170518

PMID:29103033

Abstract

BACKGROUND

Current information is scarce regarding comorbid conditions, treatment, survival, institutionalization, and health care utilization for Alzheimer's disease (AD) patients.

OBJECTIVES

Compare all-cause mortality, rate of institutionalization, and economic burden between treated and untreated newly-diagnosed AD patients.

METHODS

Patients aged 65-100 years with ≥1 primary or ≥2 secondary AD diagnoses (ICD-9-CM:331.0] with continuous medical and pharmacy benefits for ≥12 months pre-index and ≥6 months post-index date (first AD diagnosis date) were identified from Medicare fee-for-service claims 01JAN2011-30JUN2014. Patients with AD treatment claims or AD/AD-related dementia diagnosis during the pre-index period were excluded. Patients were assigned to treated and untreated cohorts based on AD treatment received post-index date. Total 8,995 newly-diagnosed AD patients were identified; 4,037 (44.8%) were assigned to the treated cohort. Time-to-death and institutionalization were assessed using Cox regression. To compare health care costs and utilizations, 1 : 1 propensity score matching (PSM) was used.

RESULTS

Untreated patients were older (83.85 versus 81.44 years; p < 0.0001), with more severe comorbidities (mean Charlson comorbidity index: 3.54 versus 3.22; p < 0.0001). After covariate adjustment, treated patients were less likely to die (hazard ratio[HR] = 0.69; p < 0.0001) and were associated with 20% lower risk of institutionalization (HR = 0.801; p = 0.0003). After PSM, treated AD patients were less likely to have hospice visits (3.25% versus 9.45%; p < 0.0001), and incurred lower annual all-cause costs ($25,828 versus $30,110; p = 0.0162).

CONCLUSION

After controlling for comorbidities, treated AD patients have better survival, lower institutionalization, and sometimes fewer resource utilizations, suggesting that treatment and improved care management could be beneficial for newly-diagnosed AD patients from economic and clinical perspectives.

摘要

背景

目前有关阿尔茨海默病（AD）患者合并症、治疗、生存、住院和医疗保健利用的信息很少。

目的

比较治疗和未治疗的新诊断 AD 患者的全因死亡率、住院率和经济负担。

方法

从 2011 年 1 月 1 日至 2014 年 6 月 30 日 Medicare 按服务收费的索赔中确定了年龄在 65-100 岁之间、有≥1 次原发性或≥2 次继发性 AD 诊断（ICD-9-CM：331.0）且在指数前 12 个月和指数后 6 个月（首次 AD 诊断日期）有连续医疗和药物福利的患者。排除了在指数前期间有 AD 治疗索赔或 AD/AD 相关痴呆诊断的患者。根据指数后日期接受 AD 治疗的情况，将患者分配到治疗和未治疗队列。共确定了 8995 例新诊断的 AD 患者；其中 4037 例（44.8%）被分配到治疗组。使用 Cox 回归评估死亡和住院时间。为了比较医疗保健成本和利用情况，使用了 1∶1 倾向评分匹配（PSM）。

结果

未治疗的患者年龄较大（83.85 岁比 81.44 岁；p<0.0001），合并症更严重（平均 Charlson 合并症指数：3.54 比 3.22；p<0.0001）。在调整了协变量后，治疗组患者死亡的可能性较小（风险比[HR]＝0.69；p<0.0001），且住院风险降低 20%（HR＝0.801；p＝0.0003）。在 PSM 后，治疗的 AD 患者接受临终关怀的可能性较小（3.25%比 9.45%；p<0.0001），且每年的全因费用较低（25828 美元比 30110 美元；p＝0.0162）。