Nuffield Department of Primary Care Health Sciences, University of Oxford, United Kingdom; MRC Integrative Epidemiology Unit, University of Bristol, United Kingdom.
MRC Integrative Epidemiology Unit, University of Bristol, United Kingdom; Population Health Sciences, University of Bristol, United Kingdom.
Econ Hum Biol. 2022 Aug;46:101154. doi: 10.1016/j.ehb.2022.101154. Epub 2022 Jun 30.
Accurate measurement of the effects of disease status on healthcare costs is important in the pragmatic evaluation of interventions but is complicated by endogeneity bias. Mendelian Randomization, the use of random perturbations in germline genetic variation as instrumental variables, can avoid these limitations. We used a novel Mendelian Randomization analysis to model the causal impact on inpatient hospital costs of liability to six prevalent diseases and health conditions: asthma, eczema, migraine, coronary heart disease, Type 2 diabetes, and depression. We identified genetic variants from replicated genome-wide associations studies and estimated their association with inpatient hospital costs on over 300,000 individuals. There was concordance of findings across varieties of sensitivity analyses, including stratification by sex and methods robust to violations of the exclusion restriction. Results overall were imprecise and we could not rule out large effects of liability to disease on healthcare costs. In particular, genetic liability to coronary heart disease had substantial impacts on costs.
准确衡量疾病状况对医疗成本的影响对于干预措施的实际评估很重要，但受到内源性偏差的影响。孟德尔随机化（利用种系遗传变异中的随机干扰作为工具变量）可以避免这些限制。我们使用一种新的孟德尔随机化分析方法，对六种常见疾病和健康状况（哮喘、湿疹、偏头痛、冠心病、2 型糖尿病和抑郁症）对住院医疗成本的因果影响进行建模。我们从经过复制的全基因组关联研究中确定了遗传变异，并在超过 30 万名个体上估计了它们与住院医疗成本的关联。敏感性分析的各种结果具有一致性，包括按性别分层和对违反排除限制稳健的方法。总体结果不够精确，我们不能排除疾病易感性对医疗成本的重大影响。特别是，冠心病的遗传易感性对成本有重大影响。
