Williams Paul V, Kavati Abhishek, Pilon Dominic, Xiao Yongling, Zhdanava Maryia, Balp Maria-Magdalena, Lefebvre Patrick, Ortiz Benjamin, Hernandez-Trujillo Vivian
Northwest Asthma and Allergy Center, Everett, WA, USA.
Novartis Pharmaceuticals Corporation, East Hanover, NY, USA.
Dermatol Ther (Heidelb). 2018 Mar;8(1):69-83. doi: 10.1007/s13555-018-0225-6. Epub 2018 Feb 10.
Few studies have described chronic idiopathic/spontaneous urticaria (CIU/CSU) healthcare burden in adults, while this information remains largely unknown in children. We aimed to describe treatment patterns, healthcare resource utilization (HRU), and costs in CIU/CSU pediatric patients, as well as to compare HRU and costs in CIU/CSU and CIU/CSU-free pediatric patients.
Medicaid claims from four states (09/01/2013-03/31/2016) were used to identify patients less than 12 years old. The CIU/CSU cohort included patients with either at least two claims for idiopathic, other, or unspecified urticaria at least 6 weeks apart, or at least one claim for urticaria and at least one claim for angioedema at least 6 weeks apart (index date defined as the first claim). The control cohort included patients without urticaria/angioedema claims (index date randomly assigned). Patients without at least 6 months of continuous Medicaid eligibility pre- and post-index were excluded. HRU and costs were compared between propensity score-matched cohorts during the post-index follow-up.
A total of 548 CIU/CSU patients (mean [SD] age 4.5 [3.3] years; 51.3% male) were matched 1:1 with controls. In the CIU/CSU cohort, 51.8% used non-sedating prescription H-antihistamines, 24.3% used oral corticosteroids, and 23.5% used other prescription H-antihistamines; 13.5% consulted allergist/immunologists and 2.4% consulted dermatologists in the first 6 months of follow-up. Compared to controls, CIU/CSU patients had significantly more per patient per year (PPPY) inpatient (incidence rate ratio [IRR] 2.05), outpatient (IRR 2.20), and emergency department (IRR 1.64) visits (all p values < 0.05). Moreover, CIU/CSU patients also had significantly higher PPPY healthcare costs (mean cost difference [MCD] $1853), driven by incremental outpatient (MCD $1286) costs (all p values < 0.01).
CIU/CSU pediatric patients had low use of non-sedating H-antihistamines and high use of oral corticosteroids. Compared to CIU/CSU-free controls in the same age group, CIU/CSU pediatric patients had higher HRU and healthcare costs.
Novartis Pharmaceuticals Corporation.
很少有研究描述成人慢性特发性/自发性荨麻疹（CIU/CSU）的医疗负担，而儿童的这一信息在很大程度上仍不为人知。我们旨在描述CIU/CSU儿科患者的治疗模式、医疗资源利用（HRU）和成本，并比较CIU/CSU患儿与无CIU/CSU患儿的HRU和成本。
利用四个州（2013年9月1日至2016年3月31日）的医疗补助索赔数据来识别12岁以下的患者。CIU/CSU队列包括至少有两项特发性、其他或未明确的荨麻疹索赔且间隔至少6周的患者，或至少有一项荨麻疹索赔和至少一项血管性水肿索赔且间隔至少6周的患者（索引日期定义为首次索赔日期）。对照组包括无荨麻疹/血管性水肿索赔的患者（索引日期随机分配）。排除索引前后连续医疗补助资格不足6个月的患者。在索引后随访期间，对倾向得分匹配队列之间的HRU和成本进行比较。
总共548例CIU/CSU患者（平均[标准差]年龄4.5[3.3]岁；51.3%为男性）与对照组进行1:1匹配。在CIU/CSU队列中，51.8%使用非镇静性处方H-抗组胺药，24.3%使用口服糖皮质激素，23.5%使用其他处方H-抗组胺药；在随访的前6个月，13.5%咨询了过敏症专科医生/免疫学家，2.4%咨询了皮肤科医生。与对照组相比，CIU/CSU患者每年每人（PPPY）的住院（发病率比[IRR]2.0）、门诊（IRR 2.20）和急诊科（IRR 1.64）就诊次数显著更多（所有p值<0.05）。此外，CIU/CSU患者的PPPY医疗成本也显著更高（平均成本差异[MCD]1853美元），这是由门诊增量成本（MCD 1286美元）驱动的（所有p值<0.01）。
CIU/CSU儿科患者非镇静性H-抗组胺药使用量低，口服糖皮质激素使用量高。与同年龄组无CIU/CSU的对照组相比，CIU/CSU儿科患者的HRU和医疗成本更高。
诺华制药公司
