Pilon Dominic, Teeple Amanda, Zhdanava Masha, Ladouceur Martin, Ching Cheung Hoi, Muser Erik, Lefebvre Patrick
a Analysis Group, Inc. , Montréal, Québec, Canada.
b Janssen Scientific Affairs, LLC , Titusville , NJ , USA.
J Med Econ. 2019 Feb;22(2):196-203. doi: 10.1080/13696998.2018.1557201. Epub 2019 Jan 3.
To evaluate the impact of comorbidities on healthcare resource use (HRU), and direct and indirect work-loss-related costs in psoriasis patients.
Adults with psoriasis (≥2 diagnoses, the first designated as the index date) and non-psoriasis controls (no psoriasis diagnoses, randomly generated index date) were identified in a US healthcare claims database of privately-insured patients (data between January 2010 and March 2017 were used). Psoriasis patients were stratified based on the number of psoriasis-related comorbidities (0, 1-2, or ≥3) developed during the 12 months post-index. All outcomes were evaluated during the follow-up period, spanning the index date until the end of continuous health plan eligibility or data cut-off. HRU and costs per-patient-per-year (PPPY) were compared in psoriasis and non-psoriasis patients with ≥12 months of follow-up.
A total of 9,078 psoriasis (mean age = 44 years, 51% female) and 48,704 non-psoriasis (mean age = 41 years, 50% female) patients were selected. During the 12 months post-index, among psoriasis vs non-psoriasis patients, 71.0% vs 83.0% developed no psoriasis-related comorbidities, 26.3% vs 16.0% developed 1-2, and 2.6% vs 1.0% developed ≥3 psoriasis-related comorbidities. Compared to non-psoriasis patients, psoriasis patients had more HRU including outpatient visits (incidence rate ratios [IRRs] = 1.52, 2.03, and 2.66 for 0, 1-2, and ≥3 comorbidities, respectively [all p < 0.01]) and emergency room visits (IRRs = 1.12, 1.59, and 2.45 for 0, 1-2, and ≥3 comorbidities, respectively [all p < 0.01]) during the follow-up period. Psoriasis patients incurred greater total healthcare costs (mean cost differences [MCDs] = $1,590, $5,870, and $18,427, in patients with 0, 1-2, and ≥3 comorbidities, respectively [all p < 0.01]), and work-loss-related costs (MCDs = $335, $655, and $1,695, in patients with 0, 1-2, and ≥3 comorbidities, respectively [all p < 0.01]).
HRU and cost burden of psoriasis are substantial, and increase with the development of psoriasis-related comorbidities.
评估合并症对银屑病患者医疗资源利用（HRU）以及与工作损失相关的直接和间接成本的影响。
在美国一个私人保险患者的医疗理赔数据库中识别出患有银屑病的成年人（≥2次诊断，首次诊断日期指定为索引日期）和非银屑病对照者（无银屑病诊断，随机生成索引日期）（使用2010年1月至2017年3月的数据）。银屑病患者根据索引后12个月内发生的银屑病相关合并症数量（0、1 - 2或≥3）进行分层。所有结局在随访期间进行评估，随访期从索引日期开始，直至连续健康计划资格结束或数据截止。对随访时间≥12个月的银屑病和非银屑病患者的HRU和每年每位患者成本（PPPY）进行比较。
共选择了9078例银屑病患者（平均年龄 = 44岁，51%为女性）和48704例非银屑病患者（平均年龄 = 41岁，50%为女性）。在索引后12个月内，银屑病患者与非银屑病患者相比，71.0% vs 83.0%未发生银屑病相关合并症，26.3% vs 16.0%发生1 - 2种，2.6% vs 1.0%发生≥3种银屑病相关合并症。与非银屑病患者相比，银屑病患者在随访期间有更多的HRU，包括门诊就诊（0、1 - 2和≥3种合并症的发病率比[IRR]分别为1.52、2.03和2.66[均p < 0.01]）和急诊就诊（0、1 - 2和≥3种合并症的IRR分别为1.12、1.59和2.45[均p < 0.01]）。银屑病患者产生了更高的总医疗成本（0、1 - 2和≥3种合并症患者的平均成本差异[MCD]分别为1590美元、5870美元和18427美元[均p < 0.01]）以及与工作损失相关的成本（0、1 - 2和≥3种合并症患者的MCD分别为335美元、655美元和1695美元[均p < 0.01]）。
银屑病的HRU和成本负担巨大，且随着银屑病相关合并症的发展而增加。
