日本老龄化乙型肝炎人群的特征和医疗保健费用：一项全国范围的真实世界分析。
Characteristics and Healthcare Costs in the Aging Hepatitis B Population of Japan: A Nationwide Real-World Analysis.
机构信息
Department of Infectious Diseases and Applied Immunology, The Hospital of The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.
Department of Gastroenterology and Hepatology, Japanese Red Cross Musahino Hospital, Tokyo, Japan.
出版信息
Dig Dis. 2022;40(1):68-77. doi: 10.1159/000515854. Epub 2021 Mar 15.
INTRODUCTION
Advancing age, comorbidity, and financial burden have been observed in chronic hepatitis B (CHB) patients globally. As Japan is leading the world in aging demographics, similar real-world data are urgently needed for its CHB population to inform all stakeholders.
METHODS
This cross-sectional study characterized the demographics, comorbidities, and healthcare costs of a large Japanese real-world adult (≥18 years) CHB patient (ICD-10: B18.1) population from the Medical Data Vision database from January 01, 2012, to December 31, 2016. Comorbidities were identified by ICD-10 codes, and the annual point prevalence and Charlson Comorbidity Index (CCI) score were calculated. Annual mean and median all-cause healthcare utilization and costs per patient were calculated. Comparison tests were conducted for CCI scores, prevalence of comorbidities, and healthcare resource utilization and costs.
RESULTS
We identified 11,125 CHB patients. Between 2012 and 2016, the mean age increased from 62.0 to 65.2 years, and the percentage of those aged ≥65 years increased from 45.6% to 60.7%. The prevalence of cirrhosis remained similar (5.8% in 2012 and 5.6% in 2016, p = 0.69) while hepatocellular carcinoma decreased from 6.3% to 4.5% (p < 0.01). The prevalence of nonliver comorbidities increased (40.9-52.0% for cancer [p < 0.01], 12.1-17.7% for osteoporosis [p < 0.01], and 10.7-15.0% for renal impairment [p < 0.01]). Healthcare resource utilization and costs also increased, with a 119.3% increase in median total healthcare costs from JPY 229,143 in 2012 to 502,467 in 2016 (p < 0.01).
CONCLUSIONS
The CHB population of Japan is predominantly elderly and carry a high nonliver comorbidity burden, while incurring increasing healthcare costs.
简介
在全球范围内，慢性乙型肝炎（CHB）患者的年龄增长、合并症和经济负担已受到关注。由于日本在人口老龄化方面处于世界领先地位，因此迫切需要针对其 CHB 人群的真实世界数据，以便为所有利益相关者提供信息。
方法
本项回顾性研究利用 Medical Data Vision 数据库，分析了 2012 年 1 月 1 日至 2016 年 12 月 31 日期间年龄≥18 岁的日本成年 CHB 患者（ICD-10：B18.1）的人口统计学特征、合并症和医疗保健费用。采用 ICD-10 编码确定合并症，并计算年度点患病率和 Charlson 合并症指数（CCI）评分。计算每位患者的年度平均和中位数全因医疗保健利用和费用。对 CCI 评分、合并症患病率以及医疗资源利用和费用进行比较检验。
结果
共纳入 11125 例 CHB 患者。2012 年至 2016 年期间，患者的平均年龄从 62.0 岁增加至 65.2 岁，≥65 岁患者的比例从 45.6%增加至 60.7%。肝硬化的患病率保持不变（2012 年为 5.8%，2016 年为 5.6%，p=0.69），而肝细胞癌的患病率从 6.3%下降至 4.5%（p＜0.01）。非肝脏合并症的患病率增加（癌症的患病率从 40.9%升至 52.0%[p＜0.01]，骨质疏松症的患病率从 12.1%升至 17.7%[p＜0.01]，肾功能损害的患病率从 10.7%升至 15.0%[p＜0.01]）。医疗资源的利用和费用也有所增加，2012 年至 2016 年间，中位数总医疗费用从 229143 日元增至 502467 日元，增长了 119.3%（p＜0.01）。
结论
日本 CHB 人群以老年人为主，非肝脏合并症负担沉重，同时医疗保健费用不断增加。
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