Division of Cardiac Surgery Department of Cardiac Sciences Libin Cardiovascular Institute Foothills Medical Center University of Calgary Alberta Canada.
Department of Surgery Kingston General Hospital Queen's University Kingston Ontario, Canada.
J Am Heart Assoc. 2020 Jun 2;9(11):e014981. doi: 10.1161/JAHA.119.014981. Epub 2020 May 27.
Background Thoracic aortic dissections (TADs) and thoracic aortic aneurysms (TAAs) are resource intensive. We sought to determine economic burden and healthcare resource use to guide health policy. Methods and Results Using universal healthcare coverage data for Ontario, Canada, from 2003 to 2016, a cost-of-illness analysis was performed. From a single-payer's perspective, direct costs (hospitalization, reinterventions, readmissions, rehabilitation, extended care, home care, prescription drugs, and imaging) were assessed in 2017 Canadian dollars. Controls without TADs or TAAs were matched 10:1 on age, sex, and socioeconomic status to cases with TADs or TAAs to compare posthospital service use to the general population. Linear and spline regression were used for cost trends. Total hospital costs increased from $9 M to $20.7 M for TADs (<0.0001) and $13 M to $18 M for TAAs (<0.001). Costs cumulated to $587 M for 17 113 cases. Median hospital costs for TADs were $11 525 ($6102 medical, $26 896 endograft, and $30 372 surgery) with an increase over time (=0.04). For TAAs, median costs were $16 683 ($7247 medical, $11 679 endograft, and $22 949 surgery) with a decrease over time (=0.03). Home care was the most used posthospital service (TADs 44%, TAAs 38%), but rehabilitation had the highest median cost (TADs $11.9 M, TAAs $11 M). Men had increased median costs for indexed hospitalizations relative to women, yet women used more posthospital services with higher service costs. Conclusions Total yearly costs have increased for TADs and TAAs. Median hospital costs have increased for TADs yet decreased for TAAs. Women use posthospital healthcare services more often than men.
胸主动脉夹层（TAD）和胸主动脉瘤（TAA）需要耗费大量资源。我们旨在确定经济负担和医疗资源的使用情况，为卫生政策提供指导。
利用加拿大安大略省的全民医疗保健覆盖数据，对 2003 年至 2016 年的医疗成本进行了分析。从单一付款人的角度来看，评估了 2017 年的直接成本（住院、再干预、再入院、康复、长期护理、家庭护理、处方药和影像学）。未发生 TAD 或 TAA 的对照组，按年龄、性别和社会经济地位与 TAD 或 TAA 病例进行 10:1 匹配，以比较住院后服务的使用情况与一般人群。线性和样条回归用于成本趋势分析。TAD 的总住院费用从 900 万加元增加到 2070 万加元（<0.0001），TAA 的总住院费用从 1300 万加元增加到 1800 万加元（<0.001）。17113 例患者累计花费 5.87 亿加元。TAD 的中位住院费用为 11525 加元（6102 医疗费用、26896 支架费用和 30372 手术费用），随着时间的推移呈上升趋势（=0.04）。TAA 的中位费用为 16683 加元（7247 医疗费用、11679 支架费用和 22949 手术费用），随着时间的推移呈下降趋势（=0.03）。家庭护理是最常用的住院后服务（TAD 为 44%，TAA 为 38%），但康复的中位费用最高（TAD 为 1190 万加元，TAA 为 1100 万加元）。与女性相比，男性的索引住院费用中位数更高，但女性使用的住院后服务更多，服务费用也更高。
TAD 和 TAA 的年度总成本有所增加。TAD 的中位住院费用增加，而 TAA 的中位住院费用下降。女性比男性更频繁地使用住院后医疗服务。
