Department of Neurology, Penn State University, Hershey, PA, USA; Department of Public Health Sciences, Division of Epidemiology, Penn State University, Hershey, PA, USA.
Penn State College of Medicine, Hershey, PA, USA.
Epilepsy Behav. 2020 Nov;112:107430. doi: 10.1016/j.yebeh.2020.107430. Epub 2020 Sep 18.
Epilepsy exacts substantial adverse economic and quality of life (QoL) costs. Clarifying the quantitative and qualitative relationships between total and out-of-pocket (OOP) healthcare expenditures and QoL could shed insights into how they influence each other, and have done so over recent times.
We used the Medical Expenditure Household Components 2003-2014 to identify a total of 2450 adults with epilepsy, representing a weighted population of 1,942,413. Quality of life was assessed using the Physical Component Summary (PCS) and the Mental Component Summary (MCS) derived from the Short-form 12 Version 2 (SF-12 V2), converted into quartiles of equal distribution, with higher quartiles indicating a better QoL. We computed unadjusted mean and adjusted (through a generalized linear model (GLM)) total and OOP healthcare expenditures by QoL categories among adults with epilepsy (reported as dollars in 2016).
The pooled estimates of total healthcare expenditures decreased as PCS and MCS quartiles of QoL increased [PCS: costs for quartile 1 = $21,792 (95% confidence interval (CI): $18,416-$25,168 vs. costs for quartile 4 = $6057 (95% CI: $4648-$7466) and MCS: costs for quartile 1 = $19,040 (95% CI: $15,544-$22,535) vs. quartile 4 = $12,939 (95% CI: $8450-$17,429)]. Similarly, the pooled estimates of OOP healthcare expenditures and QoL were inversely related [PCS: costs for quartile 1 = $1849 (95% CI: $1583-$2114) vs. costs for quartile 4 = $948 ($709-$1187) and MCS: costs for quartile 1 = 1812 (95% CI: $1483-2141) vs. quartile 4 = $1317 (95% CI: $982-$1652)]. The association between QoL and total and OOP healthcare expenditures was unchanged after adjusting for socioeconomic and healthcare system related confounders in the GLM. Overall, healthcare expenditures were stable across years independently of the QoL; only OOP expenditures decreased between 2003-2006 and 2011-2014 for quartile 1 of PCS and MCS.
Quality of life and OOP health expenditures are independently and inversely related to each other among adults with epilepsy. Over the decade studied in the United States, there was a decrease in OOP health expenditures among those patients with epilepsy with the lowest QoL, possibly reflecting a rise in insurance coverage after the Affordable Care Act.
癫痫会带来巨大的经济和生活质量（QoL）成本。阐明总医疗支出和自付医疗支出（OOP）与 QoL 之间的定量和定性关系，可以深入了解它们是如何相互影响的，以及近年来它们是如何相互影响的。
我们使用 2003-2014 年的医疗支出家庭成分，确定了总共 2450 名患有癫痫的成年人，代表了 1942413 名加权人口。使用身体成分摘要（PCS）和精神成分摘要（MCS）来评估生活质量，这些摘要来自简短格式 12 版本 2（SF-12 V2），转换为相等分布的四分位数，较高的四分位数表示 QoL 更好。我们计算了癫痫患者按 QoL 类别（以 2016 年美元计）的未经调整的平均和调整（通过广义线性模型（GLM））的总医疗支出和 OOP 医疗支出。
随着 PCS 和 MCS QoL 四分位数的增加，总医疗支出的 pooled 估计值降低[PCS：四分位数 1 的成本为$21792（95%置信区间（CI）：$18416-$25168）与四分位数 4 的成本$6057（95% CI：$4648-$7466）和 MCS：四分位数 1 的成本为$19040（95% CI：$15544-$22535）与四分位数 4 的成本$12939（95% CI：$8450-$17429）]。同样，OOP 医疗支出和 QoL 的 pooled 估计值呈负相关[PCS：四分位数 1 的成本为$1849（95% CI：$1583-$2114）与四分位数 4 的成本$948（$709-$1187）和 MCS：四分位数 1 的成本为$1812（95% CI：$1483-2141）与四分位数 4 的成本$1317（95% CI：$982-$1652）]。在 GLM 中调整了社会经济和医疗保健系统相关混杂因素后，QoL 与总医疗支出和 OOP 医疗支出之间的关联保持不变。总体而言，医疗支出在 QoL 方面保持稳定，不受影响；仅在 PCS 和 MCS 的四分位数 1 中，OOP 支出在 2003-2006 年至 2011-2014 年间有所下降。
在美国研究的十年中，癫痫患者的 OOP 医疗支出与生活质量呈独立的负相关关系。在经济可承受的医疗法案后，保险覆盖范围可能增加，这可能反映出在该法案之后，那些 QoL 最低的癫痫患者的 OOP 医疗支出有所下降。
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