2015 年加利福尼亚州受益人中唐氏综合征痴呆症与阿尔茨海默病相比给医疗保险带来的直接医疗保健费用。
The direct health care cost to Medicare of Down syndrome dementia as compared with Alzheimer's disease among 2015 Californian beneficiaries.
机构信息
Laboratoire d'imagerie biomédicale, department of physical rehabilitation medicine GRC24, Sorbonne Université, Pitié-Salpêtrière hospital, AP-HP, Paris, France; Memory and Aging Center, Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA.
Memory and Aging Center, Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA; Departments of psychiatry, neurology and epidemiology and biostatistics, University of California San Francisco, San Francisco, CA, USA.
出版信息
Ann Phys Rehabil Med. 2021 Jan;64(1):101430. doi: 10.1016/j.rehab.2020.07.011. Epub 2020 Oct 15.
BACKGROUND
Aging individuals with Down syndrome (DS) are at increased risk of dementia due to trisomy of chromosome 21 on which the amyloid precursor protein gene is located and with increased life expectancy. Yet, little is known about the costs associated with DS dementia and how this compares to Alzheimer's disease (AD).
OBJECTIVE
To better understand direct healthcare costs and care consumption in DS dementia, we compared the total cost of care to US Medicare and the drivers of these medical expenditures in individuals with DS with and without dementia, and in those with AD without DS.
METHODS
The effect of dementia in DS on costs and care utilization was estimated with 2015 California Medicare fee-for-service data (parts A and B). Among 3,001,977 Californian Medicare beneficiaries, 353 individuals had DS with dementia (age 45-89 years). We compared their number of chronic comorbidity conditions among 27 and their care and Medicare costs to those of age- and sex-matched individuals with DS without dementia and those with AD without DS.
RESULTS
Medicare annual cost per beneficiary was a mean of 43.5% and 82.2% higher with DS dementia (mean $35,011) than DS without dementia (mean $24,401) and AD without dementia (mean $19,212), related to greater utilization of inpatient services. DS dementia was associated with increased level of multimorbidity (mean of 3.4 conditions in addition to dementia vs. 2.7 and 2.2 conditions for DS without dementia and AD, respectively), with more emergency room visits (88% vs. 76.5% and 54.4%) and with more primary care physician visits (91.2% vs. 87.3% and 81.3%).
CONCLUSION
DS adults with dementia have higher health care costs than DS adults without dementia and adults with AD. Understanding costs and complex health care needs in DS dementia could facilitate management of adult and geriatric care resources for these high-need high-cost individuals.
背景
唐氏综合征（DS）患者随着年龄的增长，由于 21 号染色体三体，即淀粉样前体蛋白基因所在的染色体，以及预期寿命的延长，患痴呆症的风险增加。然而，人们对与 DS 痴呆相关的成本知之甚少，也不清楚与阿尔茨海默病（AD）相比，这些成本如何。
目的
为了更好地了解 DS 痴呆症患者的直接医疗保健成本和护理消耗，我们比较了有和没有痴呆症的 DS 患者以及没有 DS 的 AD 患者的总护理成本以及这些医疗支出的驱动因素。
方法
使用 2015 年加州医疗保险服务费用数据（A 部分和 B 部分）估计痴呆症对 DS 成本和护理利用的影响。在 3001977 名加利福尼亚州医疗保险受益人中，有 353 名患有 DS 痴呆症（年龄 45-89 岁）。我们比较了他们 27 种慢性共病的数量及其护理和医疗保险费用，与年龄和性别匹配的没有 DS 痴呆症的 DS 患者以及没有 DS 的 AD 患者进行了比较。
结果
每位受益人的 Medicare 年平均费用分别为 DS 痴呆症（平均 35011 美元）比 DS 无痴呆症（平均 24401 美元）和 AD 无痴呆症（平均 19212 美元）高 43.5%和 82.2%，这与住院服务的利用率增加有关。DS 痴呆症与更高水平的多种合并症相关（除痴呆症外还有 3.4 种疾病，而 DS 无痴呆症和 AD 分别为 2.7 和 2.2 种疾病），急诊就诊率更高（88%比 76.5%和 54.4%），初级保健医生就诊率更高（91.2%比 87.3%和 81.3%）。
结论
患有痴呆症的 DS 成年人的医疗保健费用高于没有痴呆症的 DS 成年人和患有 AD 的成年人。了解 DS 痴呆症的成本和复杂的医疗保健需求，可以为这些高需求高成本的人群管理成人和老年护理资源提供便利。
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