美国肾移植受者抗体介导排斥反应的成本、医疗利用和结果。

Cost, healthcare utilization, and outcomes of antibody-mediated rejection in kidney transplant recipients in the US.

机构信息

Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, MN, USA.

University of Minnesota Medical School, Minneapolis, MN, USA.

出版信息

J Med Econ. 2021 Jan-Dec;24(1):1011-1017. doi: 10.1080/13696998.2021.1964267.

DOI:10.1080/13696998.2021.1964267

PMID:34348559

Abstract

BACKGROUND

Antibody-mediated rejection (AMR) is one of the leading causes of graft loss in kidney transplant recipients but little is known about the associated cost and healthcare burden of AMR.

METHODS

We developed an algorithm to detect AMR using the 2006-2011 Centers for Medicare & Medicaid Services (CMS) using ICD-10 and billing codes as there is no specific ICD-10 or procedure code for AMR. We then compared healthcare utilization, cost, and risk of graft failure or death in AMR. patients versus matched controls.

RESULTS

The algorithm had a 39.4% true-positive rate (69/175) and a 4.1% false-positive rate (110/2,655). We identified 5,679/101,554 (5.6%) with AMR, who had a nearly 3-fold higher risk of graft failure (hazard ratio [HR], 2.75, 95% confidence interval [CI], 2.50 to 3.03; < .0001) and death (HR, 2.59; 95% CI, 2.35 to 2.86; < .0001) at 2 years, nearly 5 times the hospitalizations in the 60 d before AMR diagnosis, and increased nephrology and emergency department visits. Mean AMR attributable healthcare costs were 4 times higher than matched controls, at $13,066 more per patient in the 60 d before AMR diagnosis and $35,740 per patient per year higher in the 2 years after AMR diagnosis.

CONCLUSIONS

US kidney transplant recipients with AMR have substantially greater healthcare utilization and higher costs and risk of graft loss and mortality.

摘要

背景

抗体介导的排斥反应（AMR）是导致肾移植受者移植物丢失的主要原因之一，但对于 AMR 相关的成本和医疗负担知之甚少。

方法

我们开发了一种使用 2006-2011 年美国医疗保险和医疗补助服务中心（CMS）的 ICD-10 和计费代码来检测 AMR 的算法，因为目前没有针对 AMR 的特定 ICD-10 或程序代码。然后，我们比较了 AMR 患者与匹配对照患者的医疗保健利用、成本和移植物失败或死亡的风险。

结果

该算法的真阳性率为 39.4%（69/175），假阳性率为 4.1%（110/2655）。我们确定了 5679/101554（5.6%）的患者患有 AMR，他们的移植物失败风险增加了近 3 倍（风险比[HR]，2.75，95%置信区间[CI]，2.50 至 3.03；<0.0001），死亡风险增加了 2.59 倍（HR，2.59；95%CI，2.35 至 2.86；<0.0001），在 AMR 诊断前的 60 天内，住院次数增加了近 5 倍，肾脏科和急诊科就诊次数增加。AMR 归因于医疗保健的平均成本是匹配对照组的 4 倍，在 AMR 诊断前的 60 天内每位患者多花费 13066 美元，在 AMR 诊断后的 2 年内每位患者每年多花费 35740 美元。