Shing Emily, Wang John, Khoo Edwin, Evans Gerald A, Moore Stephen, Nelder Mark P, Patel Samir N, Russell Curtis, Sider Doug, Sander Beate
Public Health Ontario, Toronto, Ontario, Canada.
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
Zoonoses Public Health. 2019 Jun;66(4):428-435. doi: 10.1111/zph.12560. Epub 2019 Jan 21.
The objective of this study was to determine healthcare costs attributable to laboratory-confirmed Lyme disease (LD) from the healthcare payer perspective in Ontario, Canada. A cost-of-illness study was conducted for incident LD subjects from 1 January 2006 through 31 December 2013 ascertained from provincial laboratory and reportable disease databases, linked to health administrative data. All LD subjects included were laboratory-confirmed, according to provincial case definitions. Incident LD subjects were propensity-score matched to uninfected subjects on age, sex, comorbidities and urban/rural status. We used phase-of-care methods to calculate attributable costs for two phases of illness: initial care (≤30 days following "index date") and continuing care (>30 days after index date to the end of the follow-up period). A total of 663 incident, confirmed LD subjects were identified from 2006 through 2013. Mean age was 44.2 ± 20.1 years; 339 (51.1%) were female; and 31 (4.7%) were hospitalized ≤30 days after index date. Six hundred fifty-eight (99.2%) LD subjects were matched to uninfected subjects; mean follow-up time was 3.3 years. Mean attributable costs per case during the initial care phase and continuing care were $277 (95% CI: $197, $357) and -$5 (-$27, $17), respectively. Attributable costs per LD subject aged 5-14 years were $440 ($132, $747), greater than the costs observed for other age strata. Expected 1-year attributable costs were $832, given continuing care costs were negligible. Limitations to our study include estimating costs using a cohort of only laboratory-confirmed LD cases, introducing selection bias for diagnosed and treated patients who may have a lower risk of developing sequelae. In conclusion, the initial care phase of LD is associated with increased healthcare costs, but without significant costs attributable to LD infection after 30 days. Estimates of costs attributable to LD are important for healthcare resource prioritization and the evaluation of novel interventions.
本研究的目的是从加拿大安大略省医疗保健支付方的角度，确定实验室确诊的莱姆病（LD）所产生的医疗费用。我们对2006年1月1日至2013年12月31日期间确诊的LD患者进行了一项疾病成本研究，这些患者通过省级实验室和法定报告疾病数据库确定，并与卫生行政数据相关联。根据省级病例定义，所有纳入的LD患者均为实验室确诊。将确诊的LD患者按照年龄、性别、合并症和城乡状况进行倾向得分匹配，与未感染的患者进行对照。我们采用照护阶段方法计算疾病两个阶段的归因成本：初始照护阶段（“索引日期”后≤30天）和持续照护阶段（索引日期后>30天至随访期结束）。2006年至2013年期间，共识别出663例确诊的LD患者。平均年龄为44.2±20.1岁；339例（51.1%）为女性；31例（4.7%）在索引日期后≤30天住院。658例（99.2%）LD患者与未感染患者进行了匹配；平均随访时间为3.3年。初始照护阶段和持续照护阶段每例患者的平均归因成本分别为277美元（95%CI：197美元，357美元）和 -5美元（-27美元，17美元）。5至14岁LD患者的每例归因成本为440美元（132美元，747美元），高于其他年龄组的成本。考虑到持续照护成本可忽略不计，预计1年的归因成本为832美元。本研究的局限性包括仅使用实验室确诊的LD病例队列来估计成本，这可能会对诊断和治疗的患者引入选择偏倚，而这些患者发生后遗症的风险可能较低。总之，LD的初始照护阶段与医疗费用增加相关，但30天后LD感染所致的成本并不显著。LD归因成本的估计对于医疗资源的优先分配和新型干预措施的评估很重要。
