Analysis Group, Inc, Montreal, QC, Canada.
Janssen Scientific Affairs, LLC, Horsham, PA, USA.
J Med Econ. 2020 Oct;23(10):1092-1101. doi: 10.1080/13696998.2020.1789649. Epub 2020 Jul 14.
To quantify the long-term direct and indirect costs among patients with Crohn's disease (CD) and specific subgroups of these patients in the United States from the private payer's perspective.
This retrospective study used the OptumHealth Care Solutions, Inc database (01 January 1999-31 March 2017) to match (1:5) adult patients with ≥2 claims for CD to patients without inflammatory bowel disease (IBD). Patterns observed during follow-up (i.e. biologics, opioids, or steroids; CD-related surgery; moderate-to-severe disease; and comorbidities) were used to identify CD subgroups. Comparisons of healthcare resource utilization, work loss days, and direct and indirect work loss-related costs were made between matched cohorts. Descriptive analyses of costs were conducted within each CD subgroup.
There were 6,715 and 33,575 patients in the CD and non-IBD cohorts, respectively. The direct burden was significantly higher in the CD cohort compared to the non-IBD cohort, with 0.34 inpatient admissions per patient per year (PPPY) versus 0.12 (217% increase; < .001), and $24,500 direct healthcare costs PPPY versus $7,037 ($17,463 increase; < .001). The trend was similar for the indirect burden, with work loss-related costs PPPY of $5,490 in the CD cohort versus $3,322 in the non-IBD cohort ($2,168 increase; < .001). The burden was numerically higher in the CD subgroups, with direct healthcare costs reaching $101,013 PPPY in the surgery subgroup.
Severity of CD was determined based on claims-based algorithms due to the lack of access to medical files. Absenteeism was imputed based on claims data, and presenteeism was not assessed.
The direct healthcare and indirect work loss-related costs of patients with CD was significantly higher compared to patients without IBD over an average follow-up of 5 years.
从私人支付者的角度定量评估美国克罗恩病（CD）患者及其特定亚组的长期直接和间接成本。
本回顾性研究使用 OptumHealth Care Solutions, Inc. 数据库（1999 年 1 月 1 日至 2017 年 3 月 31 日），将≥2 次 CD 就诊记录的成年患者与无炎症性肠病（IBD）的患者（1:5）进行匹配。通过随访期间的观察模式（即生物制剂、阿片类药物或皮质类固醇、CD 相关手术、中重度疾病和合并症），确定 CD 亚组。对匹配队列的医疗资源利用、误工天数以及直接和间接与误工相关的成本进行比较。在每个 CD 亚组内对成本进行描述性分析。
CD 队列和非 IBD 队列中分别有 6715 例和 33575 例患者。与非 IBD 队列相比，CD 队列的直接负担显著更高，每位患者每年的住院人次为 0.34 次（PPPY），而非 IBD 队列为 0.12 次（增加 217%；<0.001），CD 队列的直接医疗保健成本 PPPY 为 24500 美元，而非 IBD 队列为 7037 美元（增加 17463 美元；<0.001）。间接负担也存在类似趋势，CD 队列的误工相关成本 PPPY 为 5490 美元，而非 IBD 队列为 3322 美元（增加 2168 美元；<0.001）。在 CD 亚组中，负担的数值更高，手术亚组的直接医疗保健成本达到 PPPY101013 美元。
由于无法获取医疗档案，因此根据索赔的算法来确定 CD 的严重程度。缺勤是根据索赔数据推断的，而工作效率未进行评估。
与无 IBD 的患者相比，CD 患者的直接医疗保健和间接与误工相关的成本在平均 5 年的随访中显著更高。
