Division of Immunology/Rheumatology, Stanford University, Palo Alto, CA, USA.
Pharmerit, Bethesda, MD, USA.
Curr Med Res Opin. 2020 Jan;36(1):161-168. doi: 10.1080/03007995.2019.1658974. Epub 2019 Sep 23.
Determine healthcare resource utilization (HCRU) and costs associated with fatigue and stiffness among patients with rheumatoid arthritis (RA). A retrospective claims analysis compared RA patients with fatigue or stiffness to matched RA control patients with neither. Claims from a large US commercial insurance database identified new cases of stiffness/fatigue among newly diagnosed patients. Study patients had ≥2 medical claims for RA ≥45 days apart, continuous insurance coverage ≥12 months before RA index (baseline period) and ≥12 months after fatigue/stiffness index (follow-up period). Controls had no diagnosis of fatigue or stiffness ≥12 months before index. Cases had ≥1 claim of fatigue/stiffness after RA index; the first such claim was the index date. Multivariate logistic regressions, adjusting for baseline demographics, comorbidities, medication use and HCRU, were used to predict the propensity of having a fatigue/stiffness diagnosis. Controls were propensity-score matched to cases. Generalized linear models estimated all-cause and RA-specific costs associated with resource use as well as prescription drugs, adjusting for any unbalanced covariates after propensity-score matching. Approximately 32% of newly diagnosed RA patients suffer from fatigue/stiffness. Matched cohorts were analyzed: fatigue vs. control; stiffness vs. control; fatigue and stiffness vs. control. After RA diagnosis, hospitalizations increased: 83% for fatigue, 117% for stiffness and 148% for both; total office visits increased 63%, 113% and 135%, respectively. Greater HCRU yielded significantly greater (all < .001) per-patient-per-year hospitalization costs vs. matched controls: fatigue ($2554 vs. $1293); stiffness ($2792 vs. $892); fatigue and stiffness ($3322 vs. $1033). Per-patient-per-year costs of office visits increased significantly (all < .001) vs. matched controls: fatigue ($1373 vs. $908); stiffness ($1580 vs. $761); fatigue and stiffness ($1989 vs. $921). RA patients with fatigue and/or stiffness report more HCRU and incur significantly higher medical costs than RA patients without them.
确定类风湿关节炎（RA）患者疲劳和僵硬相关的医疗资源利用（HCRU）和成本。一项回顾性理赔分析比较了有疲劳或僵硬的 RA 患者与既没有疲劳也没有僵硬的匹配 RA 对照患者。来自美国大型商业保险数据库的理赔数据确定了新诊断的 RA 患者中出现僵硬/疲劳的新病例。研究患者在 RA 指数（基线期）前至少有 2 次相隔≥45 天的 RA 医疗索赔，且在 RA 指数前至少有 12 个月的连续保险覆盖，以及在疲劳/僵硬指数后至少有 12 个月的保险覆盖（随访期）。对照患者在指数前至少有 12 个月没有疲劳或僵硬的诊断。病例在 RA 指数后至少有 1 次疲劳/僵硬的索赔；第一次此类索赔即为指数日期。使用多变量逻辑回归，根据基线人口统计学、合并症、药物使用和 HCRU 调整，预测出现疲劳/僵硬诊断的倾向。对照患者根据倾向得分与病例相匹配。使用广义线性模型估计与资源使用相关的全因和 RA 特异性成本，以及与倾向得分匹配后任何不平衡协变量调整后的处方药成本。大约 32%的新诊断的 RA 患者患有疲劳/僵硬。对匹配队列进行了分析：疲劳与对照；僵硬与对照；疲劳和僵硬与对照。RA 诊断后，住院治疗增加：疲劳增加 83%，僵硬增加 117%，两者均增加 148%；总门诊就诊次数分别增加 63%、113%和 135%。更高的 HCRU 导致与匹配对照相比，每位患者每年的住院费用显著增加（均<.001）：疲劳（$2554 与$1293）；僵硬（$2792 与$892）；疲劳和僵硬（$3322 与$1033）。与匹配对照相比，每位患者每年的门诊就诊费用显著增加（均<.001）：疲劳（$1373 与$908）；僵硬（$1580 与$761）；疲劳和僵硬（$1989 与$921）。有疲劳和/或僵硬的 RA 患者报告的 HCRU 更多，医疗费用显著高于没有疲劳和/或僵硬的 RA 患者。
