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早期慢性阻塞性肺疾病患者的早期管理的经济影响:一项基于人群的全国性调查结果。

The Economic Effect of Early Management in Patients with Early Chronic Obstructive Pulmonary Disease: Results from a Population-Based Nationwide Survey.

机构信息

Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Korea University Medical Center, Guro Hospital, Seoul, Republic of Korea.

Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

出版信息

Lung. 2019 Jun;197(3):303-313. doi: 10.1007/s00408-019-00208-5. Epub 2019 Mar 11.

Abstract

PURPOSE

The economic effect of regular follow-up and early management in patients with early chronic obstructive pulmonary disease (COPD) has not yet been clarified. Therefore, this study aimed to estimate the economic effect of regular follow-up and early management in these patients.

METHODS

Patients with early COPD were identified from the Korea National Health and Nutrition Examination Survey. We analyzed medical utilization and cost for 2 years without any missing data by using the Korean National Health Insurance data. Patients with routine healthcare maintenance were defined as, after diagnosis, those with regular visits to the hospital and receiving early management of COPD.

RESULTS

Among 1204 patients with early COPD, the patients who were classified as the group with routine healthcare maintenance (69/146; 47.3%) and the group with intermittent healthcare user (79/1058; 7.5%) visited to hospital for the next 2 years. The patients with routine healthcare maintenance had lower cost of inpatient service and frequencies of emergency room (ER) visit and intensive care unit (ICU) admission than intermittent healthcare users (cost of inpatient service, $4595 vs. $4953 per person; ER visit, 7.2 vs. 11.5; ICU admission, 4.3 vs. 7.7). Even in patients with COPD and FEV ≥ 80, early intervention through follow-up reduced the cost of inpatient service because these patients could have had less severe acute exacerbations than intermittent healthcare users.

CONCLUSION

Patients with early COPD, even those with FEV ≥ 80, need regular follow-up for early management and disease control as well as for reducing the socioeconomic burden of the disease.

摘要

目的

定期随访和早期管理对早期慢性阻塞性肺疾病(COPD)患者的经济影响尚未明确。因此,本研究旨在评估对这些患者进行定期随访和早期管理的经济效果。

方法

从韩国国家健康和营养检查调查中确定了早期 COPD 患者。我们使用韩国国家健康保险数据对无任何缺失数据的 2 年医疗利用和成本进行了分析。常规医疗保健维持是指在诊断后定期到医院就诊并接受 COPD 早期管理的患者。

结果

在 1204 例早期 COPD 患者中,有 69/146(47.3%)例患者被归类为常规医疗保健维持组,79/1058(7.5%)例患者被归类为间断医疗保健使用者组。在接下来的 2 年内,常规医疗保健维持组患者的住院服务费用和急诊室(ER)就诊次数以及重症监护病房(ICU)入院次数均低于间断医疗保健使用者(住院服务费用,4595 美元/人 vs. 4953 美元/人;ER 就诊次数,7.2 次 vs. 11.5 次;ICU 入院次数,4.3 次 vs. 7.7 次)。即使在 FEV≥80 的 COPD 患者中,通过随访进行早期干预也可以降低住院服务费用,因为这些患者的急性加重程度可能比间断医疗保健使用者轻。

结论

即使 FEV≥80 的早期 COPD 患者也需要定期随访和早期管理,以控制疾病并减轻疾病的社会经济负担。

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