美国慢性肾脏病患者临终住院治疗费用：来自 DISCOVER CKD 回顾性队列研究的报告。
Cost of End-of-Life Inpatient Encounters in Patients with Chronic Kidney Disease in the United States: A Report from the DISCOVER CKD Retrospective Cohort.
机构信息
Kolling institute, Royal North Shore Hospital, University of Sydney, Sydney, NSW, 2065, Australia.
BioPharmaceuticals Business Unit, AstraZeneca, Cambridge, UK.
出版信息
Adv Ther. 2022 Mar;39(3):1432-1445. doi: 10.1007/s12325-021-02010-3. Epub 2022 Feb 3.
INTRODUCTION
Real-world data reporting healthcare resource utilisation and costs associated with end-of-life care for patients with chronic kidney disease (CKD) are limited. We examined length of hospitalisation and costs associated with end-of-life inpatient encounters using retrospective data from DISCOVER CKD.
METHODS
Data on inpatient encounters for patients with CKD aged ≥ 18 years between January 2016 and March 2020 were extracted from the US Premier Hospital Database. Encounters ending in death were identified and grouped by reason for the encounter, using the International Classification of Diseases, Tenth Revision, and by their insurance coverage. Encounters were evaluated overall and stratified according to cardiovascular (CV), kidney failure and infection-related reasons, and by their coverage by commercial, Medicaid, Medicare or other insurers. Length of hospitalisation and total costs were calculated for encounters.
RESULTS
Among 237,734 encounters ending in death, the mean [standard deviation (SD)] age was 74.2 (12.4) years, and 45.3% of patients were female. In total, 25,118, 4210 and 76,307 encounters were classified as relating to CV reasons, kidney failure and infection, respectively. Among all encounters, the mean (SD) length of hospitalisation ranged from 9.1 (11.2) (Medicare) to 12.8 (18.4) (Medicaid) days. Across insurers, encounters related to kidney failure were associated with the longest hospitalisations compared with CV and infection [mean range (days): 10.7-15.9 vs. 7.5-10.5 and 8.7-12.7, respectively]. The median [interquartile range (IQR)] total cost of any inpatient encounter was $17,057 ($8040-35,873). Kidney failure-related encounters had higher costs compared with CV and infection [median (IQR), $18,469 ($8673-38,315) vs. $17,503 ($7766-39,693) and $16,403 ($7762-34,910), respectively]. Medicaid-covered encounters had the highest costs of all insurers [median (IQR), $16,189 ($7725-33,443)].
CONCLUSIONS
Among patients with CKD, end-of-life encounters were most frequently related to infection. Encounters relating to kidney failure incurred the highest costs.
TRIAL REGISTRATION
ClinicalTrials.gov identifier: NCT04034992.
简介
有关慢性肾脏病（CKD）患者临终关怀相关医疗资源利用和成本的真实世界数据报告十分有限。我们利用 DISCOVER CKD 的回顾性数据，研究了与终末期住院患者相关的住院时间和成本。
方法
从美国 Premier 医院数据库中提取了 2016 年 1 月至 2020 年 3 月期间年龄≥18 岁的 CKD 患者的住院患者数据。根据国际疾病分类第十次修订版（ICD-10）的原因识别并分组了以死亡为结局的住院患者，并根据他们的保险范围进行分组。根据心血管（CV）、肾衰竭和感染相关原因以及商业、医疗补助、医疗保险或其他保险覆盖情况对住院患者进行了整体评估和分层。计算了住院患者的住院时间和总费用。
结果
在 237734 例以死亡为结局的住院患者中，平均（标准差）年龄为 74.2（12.4）岁，45.3%的患者为女性。总共，25118、4210 和 76307 例被归类为与 CV 原因、肾衰竭和感染相关的住院患者。在所有住院患者中，平均（标准差）住院时间范围为 9.1（11.2）天（医疗保险）至 12.8（18.4）天（医疗补助）。在所有保险公司中，与肾衰竭相关的住院患者的住院时间最长，与 CV 和感染相关的住院患者相比[平均范围（天）：10.7-15.9 比 7.5-10.5 和 8.7-12.7]。任何住院患者的中位数（四分位距[IQR]）总费用为 17057 美元（8040-35873 美元）。肾衰竭相关的住院患者比 CV 和感染相关的住院患者的费用更高[中位数（IQR）：18469 美元（8673-38315 美元）比 17503 美元（7766-39693 美元）和 16403 美元（7762-34910 美元）]。医疗保险覆盖的住院患者的费用是所有保险公司中最高的[中位数（IQR）：16189 美元（7725-33443 美元）]。
结论
在 CKD 患者中，临终关怀相关的住院患者最常与感染相关。与肾衰竭相关的住院患者的费用最高。
试验注册
ClinicalTrials.gov 标识符：NCT04034992。
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