From Healthcore Inc., Wilmington, Delaware; Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, USA.
A.D. Raval, PhD, MPharm, Healthcore Inc.; A. Vyas, PhD, MS, MBA, Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island.
J Rheumatol. 2018 May;45(5):705-716. doi: 10.3899/jrheum.170368. Epub 2018 Jan 15.
With the expected rise in the arthritis population, information is required regarding trends of healthcare expenditures among individuals with arthritis in the United States. We examined temporal trends in direct and out-of-pocket (OOP) healthcare expenditures among individuals with arthritis using a nationally representative database, the Medical Expenditures Panel Survey.
The study population was composed of cross-sectional cohorts of individuals aged ≥ 18 years from 2008 to 2014. Two-part models were used to estimate the incremental total and types of annual direct and OOP healthcare expenditures (adjusted to 2014 US dollars) for arthritis, after controlling for predisposing, enabling, need, personal health practice, and external environmental factors, as per the Anderson Healthcare Behavioral Model.
An annual weighted arthritis population rose from 56.1 million in 2008 to 65.1 million in 2014. Among individuals with arthritis, the annual average direct and OOP expenditure was $10,424 [standard error (SE) = $345, aggregate = $584.8 billion] and $1493 (SE = $50, aggregate = $83.8 billion) in 2008, respectively, and $910 (SE = $279, total = $645.1 billion) and $1099 (SE = $36, aggregate = $71.5 billion) in 2014, respectively. In the fully adjusted model, individuals with arthritis had significantly greater total and OOP expenditures from 2008 to 2014; however, the magnitude of incremental OOP expenditure declined from 2008 to 2014.
Although the annual direct healthcare expenditures per person remained stable over the years, the rise in proportion of the arthritis population led to a huge increase in aggregate economic burden to the US healthcare system.
随着关节炎患者人数的预期增加,需要了解美国关节炎患者的医疗保健支出趋势。我们使用全国代表性数据库——医疗支出面板调查,研究了关节炎患者直接和自付(OOP)医疗保健支出的时间趋势。
该研究人群由 2008 年至 2014 年期间年龄≥18 岁的横断面队列组成。使用两部分模型来估计关节炎患者每年的总增量和直接和 OOP 医疗保健支出类型(根据安德森医疗行为模型,调整为 2014 年的美元),同时控制了倾向因素、促成因素、需求因素、个人健康实践和外部环境因素。
每年加权关节炎患者人数从 2008 年的 5610 万增加到 2014 年的 6510 万。在关节炎患者中,每年的直接和 OOP 支出平均分别为 10424 美元(标准误差[SE] = 345 美元,总计 5848 亿美元)和 1493 美元(SE = 50 美元,总计 838 亿美元)在 2008 年,分别为 910 美元(SE = 279 美元,总计 6451 亿美元)和 1099 美元(SE = 36 美元,总计 715 亿美元)在 2014 年。在完全调整的模型中,关节炎患者在 2008 年至 2014 年间的总支出和 OOP 支出显著增加;然而,OOP 支出的增量幅度从 2008 年到 2014 年有所下降。
尽管每年人均直接医疗保健支出多年来保持稳定,但关节炎患者人数的增加导致美国医疗保健系统的总经济负担大幅增加。