H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA, USA.
Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
Med Decis Making. 2020 Jul;40(5):596-605. doi: 10.1177/0272989X20932158. Epub 2020 Jul 2.
. Intensive multidisciplinary intervention (IMI) represents a well-established treatment for pediatric feeding disorders (PFDs), but program availability represents an access care barrier. We develop an economic analysis of IMI for weaning from gastronomy tube (G-tube) treatment for children diagnosed with PFDs from the Medicaid programs' perspective, where Medicaid programs refer to both fee-for-service and managed care programs. . The 2010-2012 Medicaid Analytic eXtract claims provided health care data for children aged 13 to 72 months. An IMI program provided data on average admission costs. We employed a finite-horizon Markov model to simulate PFD treatment progression assuming 2 treatment arms: G-tube only v. IMI targeting G-tube weaning. We compared the expenditure differential between the 2 arms under varying time horizons and treatment effectiveness. . Overall Medicaid expenditure per member per month was $6814, $2846, and $1550 for the study population of children with PFDs and G-tube treatment, the control population with PFDs without G-tube treatment, and the no-PFD control population, respectively. The PFD-diagnosed children with G-tube treatment only had the highest overall expenditures across all health care settings except psychological services. The expenditure at the end of the 8-year time horizon was $405,525 and $208,218 per child for the G-tube treatment only and IMI arms, respectively. Median Medicaid expenditure was between 1.7 and 2.2 times higher for the G-tube treatment arm than for the IMI treatment arm. . Data quality issues could cause overestimates or underestimates of Medicaid expenditure. . This study demonstrated the economic benefits of IMI to treat complex PFDs from the perspective of Medicaid programs, indicating this model of care not only holds benefit in terms of improving overall quality of life but also brings significant expenditure savings in the short and long term.
. 强化多学科干预（IMI）是治疗儿科进食障碍（PFD）的成熟方法，但项目的可及性是获取治疗的障碍。我们从医疗补助计划的角度出发，为患有 PFD 的儿童从胃管（G-管）治疗过渡到 IMI 方案，建立了一个关于 IMI 方案的经济学分析，其中医疗补助计划包括按服务收费和管理式医疗计划。. 2010-2012 年 Medicaid Analytic eXtract 索赔提供了 13 至 72 个月儿童的医疗保健数据。一个 IMI 项目提供了平均住院费用数据。我们采用有限期马尔可夫模型来模拟 PFD 治疗进展，假设存在两种治疗方案：仅 G-管和针对 G-管断奶的 IMI。我们比较了两种方案在不同时间范围内和治疗效果下的支出差异。. 患有 PFD 且接受 G-管治疗的儿童的每月每名成员平均医疗补助支出为 6814 美元，患有 PFD 但不接受 G-管治疗的儿童的每月每名成员平均医疗补助支出为 2846 美元，不患有 PFD 的儿童的每月每名成员平均医疗补助支出为 1550 美元。接受 G-管治疗的 PFD 确诊儿童在所有医疗保健环境中除了心理服务外的支出最高。8 年时间内的最终支出为仅 G-管治疗组的每个儿童 405525 美元，IMI 治疗组的每个儿童 208218 美元。G-管治疗组的 Medicaid 支出中位数是 IMI 治疗组的 1.7 到 2.2 倍。. 数据质量问题可能导致 Medicaid 支出的高估或低估。. 本研究从医疗补助计划的角度展示了 IMI 治疗复杂 PFD 的经济效益，表明这种治疗模式不仅在提高整体生活质量方面具有优势，而且在短期和长期内也能带来显著的支出节省。
