Nili Mona, Dwibedi Nilanjana, Adelman Megan, LeMasters Traci, Madhavan S Suresh, Sambamoorthi Usha
Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, West Virginia, USA.
Department of Clinical Pharmacy, School of Pharmacy, West Virginia University, Morgantown, West Virginia, USA.
COPD. 2021 Jun;18(3):357-366. doi: 10.1080/15412555.2021.1909549. Epub 2021 Apr 26.
The objective of this study is to estimate the excess economic burden of Asthma-COPD Overlap (ACO) among older adults in the United States. We used a cross-sectional study design with data from a nationally representative survey of Medicare beneficiaries (Medicare Current Beneficiary Survey) linked to Medicare fee-for-service claims. Older adults with ACO had higher average total healthcare expenditures ($45,532 vs. $12,743) and higher out-of-pocket spending burden (19% vs. 8.5%) compared to those with no-asthma no-COPD (NANC). Individuals with ACO also had almost two, and 1.5 times higher expenditures compared to individuals with asthma only and COPD only, respectively. Multivariable regression models indicated that the adjusted associations of ACO to economic burden remained positive and statistically significant. In comparison with NANC, nearly three-quarters of the excess total healthcare expenditures and 83% of the out-of-pocket spending burden of older adults with ACO were explained by differences in predisposing, enabling, need, personal healthcare practices, and external factors among the two groups. The higher number of unique medications and the increased incidence of fragmented care were the leading contributors to the excess economic burden among older adults with ACO comparing to NANC individuals. Interventions that reduce the number of medications and fragmented care have the potential to reduce the excess economic burden among older adults with ACO.
本研究的目的是评估美国老年人中哮喘-慢性阻塞性肺疾病重叠综合征（ACO）的额外经济负担。我们采用横断面研究设计，数据来自与医疗保险按服务收费索赔相关联的全国代表性医疗保险受益调查（医疗保险当前受益人调查）。与无哮喘无慢性阻塞性肺疾病（NANC）的老年人相比，患有ACO的老年人平均总医疗保健支出更高（45,532美元对12,743美元），自付费用负担也更高（19%对8.5%）。与仅患有哮喘和仅患有慢性阻塞性肺疾病的个体相比，患有ACO的个体的支出分别高出近两倍和1.5倍。多变量回归模型表明，ACO与经济负担的调整后关联仍然为正且具有统计学意义。与NANC相比，ACO老年患者近四分之三的额外总医疗保健支出和83%的自付费用负担可由两组在易患因素、促成因素、需求、个人医疗保健行为和外部因素方面的差异来解释。与NANC个体相比，ACO老年患者独特药物数量较多以及碎片化护理发生率增加是导致额外经济负担的主要因素。减少药物数量和碎片化护理的干预措施有可能减轻ACO老年患者的额外经济负担。
