Owusu-Edusei Kwame, Winston Carla A, Marks Suzanne M, Langer Adam J, Miramontes Roque
Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, GA, USA.
Tuberc Res Treat. 2017;2017:3816432. doi: 10.1155/2017/3816432. Epub 2017 Oct 23.
To evaluate TB test usage and associated direct medical expenditures from 2013 private insurance claims data in the United States (US).
We extracted outpatient claims for TB-specific and nonspecific tests from the 2013 MarketScan® commercial database. We estimated average expenditures (adjusted for claim and patient characteristics) using semilog regression analyses and compared them to the Centers for Medicare and Medicaid Services (CMS) national reimbursement limits.
Among the TB-specific tests, 1.4% of the enrollees had at least one claim, of which the tuberculin skin test was most common (86%) and least expensive ($9). The T-SPOT® was the most expensive among the TB-specific tests ($106). Among nonspecific TB tests, the chest radiograph was the most used test (78%), while chest computerized tomography was the most expensive ($251). Adjusted average expenditures for the majority of tests (≈74%) were above CMS limits. We estimated that total United States medical expenditures for the employer-based privately insured population for TB-specific tests were $53.0 million in 2013, of which enrollees paid 17% ($9 million).
We found substantial differences in TB test usage and expenditures. Additionally, employer-based private insurers and enrollees paid more than CMS limits for most TB tests.
利用美国2013年私人保险理赔数据评估结核菌素试验的使用情况及相关直接医疗费用。
我们从2013年MarketScan®商业数据库中提取了针对结核病特异性和非特异性检测的门诊理赔数据。我们使用半对数回归分析估计了平均费用（根据理赔和患者特征进行调整），并将其与医疗保险和医疗补助服务中心（CMS）的国家报销限额进行比较。
在结核病特异性检测中，1.4%的参保人至少有一项理赔记录，其中结核菌素皮肤试验最为常见（86%）且费用最低（9美元）。T-SPOT®是结核病特异性检测中费用最高的（106美元）。在非特异性结核病检测中，胸部X光检查是使用最多的检测项目（78%），而胸部计算机断层扫描费用最高（251美元）。大多数检测（约74%）的调整后平均费用高于CMS限额。我们估计，2013年美国基于雇主的私人参保人群用于结核病特异性检测的医疗总费用为5300万美元，其中参保人支付了17%（900万美元）。
我们发现结核病检测的使用情况和费用存在显著差异。此外，基于雇主的私人保险公司和参保人在大多数结核病检测上支付的费用超过了CMS限额。
