Duke University Medical Center, Durham, NC.
Precision Health Economics, Boston, MA; Tufts University School of Medicine, Boston, MA.
Am Heart J. 2021 Mar;233:132-140. doi: 10.1016/j.ahj.2020.12.012. Epub 2021 Jan 15.
Few data are available on the temporal patterns of health resource utilization (HRU) and expenditures around paroxysmal supraventricular tachycardia (PSVT) diagnosis. This study assessed the longitudinal trends in HRU and expenditures in the 3 years preceding and subsequent to PSVT diagnosis.
Adult patients (age 18-65 years) with newly diagnosed PSVT were identified using administrative claims from the IBM MarketScan Research Database between January 1, 2008 and December 31, 2016 and propensity-score matched (1:1) with non-PSVT controls.
Among the 12,305 PSVT patients compared with matched controls, PSVT was associated with statistically significant higher annual rates of emergency department visits, physician office visits, inpatient hospitalizations, and diagnostic testing. HRU increased in the years preceding PSVT diagnosis, reaching its peak in the year following PSVT diagnosis. Over the 6-year follow-up period, PSVT was associated with higher mean annual per patient expenditures ($12,665) compared to matched controls ($6,004; P < .001). Upon diagnosis of PSVT, the mean expenditures per PSVT patient doubled from $11,714 in the year immediately preceding index diagnosis to $23,335 in the first postdiagnosis year. Inpatient services, diagnostic testing, and ablation procedures were the principle drivers of higher mean expenditures in the first year post-PSVT diagnosis versus the year prior to PSVT diagnosis.
PSVT presents a substantial economic burden to health care systems. The annual expenditure per PSVT patient is within the range previously reported for atrial fibrillation. The increased HRU and expenditures in the year following diagnosis, which do not return to baseline, suggest a potential gap in non-interventional, long-term PSVT management.
关于阵发性室上性心动过速(PSVT)诊断前后的医疗资源利用(HRU)和支出的时间模式,数据很少。本研究评估了 PSVT 诊断前 3 年和诊断后 3 年内 HRU 和支出的纵向趋势。
使用 IBM MarketScan Research Database 的行政索赔数据,于 2008 年 1 月 1 日至 2016 年 12 月 31 日期间,识别出 18-65 岁的新诊断 PSVT 成年患者,并与非 PSVT 对照组进行倾向评分匹配(1:1)。
与匹配的对照组相比,在 12305 例 PSVT 患者中,PSVT 与每年急诊就诊率、医生就诊率、住院率和诊断性检查显著较高相关。在 PSVT 诊断前的几年中,HRU 增加,在 PSVT 诊断后的一年达到峰值。在 6 年的随访期间,与匹配的对照组($6004)相比,PSVT 患者的平均每年每位患者支出更高($12665;P<0.001)。在诊断为 PSVT 后,PSVT 患者的平均支出在指数诊断前的一年立即增加了一倍,从$11714 增加到第一个诊断后年度的$23335。与 PSVT 诊断前一年相比,住院服务、诊断性检查和消融术是 PSVT 诊断后第一年更高的平均支出的主要驱动因素。
PSVT 对医疗保健系统造成了巨大的经济负担。每位 PSVT 患者的年支出在以前报告的心房颤动范围内。诊断后一年 HRU 和支出增加且未恢复到基线,这表明在非介入性、长期 PSVT 管理方面存在潜在差距。