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阿尔茨海默病诊断前后一年的医疗保健费用:一项丹麦基于登记的匹配队列研究。

Healthcare Costs in the Year Before and After Alzheimer's Disease Diagnosis: A Danish Register-Based Matched Cohort Study.

机构信息

Danish Centre for Health Economics, IST, SDU, Odense, Denmark.

Healthcare Outcomes Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland.

出版信息

J Alzheimers Dis. 2023;93(2):421-433. doi: 10.3233/JAD-220821.

Abstract

BACKGROUND

Alzheimer's disease (AD) carries a significant economic burden, with costs peaking around the time of diagnosis. However, the cost of diagnosis, including the time leading up to it, has not been studied thoroughly. Furthermore, regionalized healthcare structure could result in differences in the pre-diagnostic costs for people with suspected AD.

OBJECTIVE

This study set out to estimate the excess healthcare costs before and after AD diagnosis compared to a matched non-AD population and to investigate regional variation in AD healthcare costs in Denmark.

METHODS

We used a register-based cohort of 25,523 matched pairs of new cases of AD and non-AD controls. The healthcare costs included costs on medication, and inpatient-, outpatient-, and primary care visits. Generalized estimating equations were employed to estimate the excess healthcare cost attributable to diagnosing AD, and the variation in costs across regions.

RESULTS

Mean excess costs attributable to AD were € 3,284 and € 6,173 in the year before and after diagnosis, respectively. Regional differences in healthcare costs were identified in both the AD and control groups and were more pronounced in patients with AD (PwAD).

CONCLUSION

PwAD incur higher healthcare costs across all cost categories in the year before and after diagnosis. Regional differences in healthcare utilization by PwAD may reveal potential variation in access to healthcare. These findings suggest that a more standardized and targeted diagnostic process may help reduce costs and variation in access to healthcare.

摘要

背景

阿尔茨海默病(AD)带来了巨大的经济负担,其成本在诊断时达到峰值。然而,诊断成本(包括诊断前的时间)尚未得到充分研究。此外,区域化的医疗保健结构可能导致疑似 AD 患者的诊断前成本存在差异。

目的

本研究旨在估计 AD 诊断前后与匹配的非 AD 人群相比的医疗保健费用超额,并调查丹麦 AD 医疗保健费用的区域差异。

方法

我们使用了一个基于登记的 25523 对新 AD 病例和非 AD 对照的匹配队列。医疗保健费用包括药物、住院、门诊和初级保健就诊的费用。采用广义估计方程估计 AD 诊断导致的医疗保健费用超额,以及各地区之间的费用差异。

结果

AD 诊断前和诊断后分别归因于 AD 的平均超额费用为 3284 欧元和 6173 欧元。在 AD 组和对照组中都发现了医疗保健费用的区域差异,且在 AD 患者(PwAD)中更为明显。

结论

PwAD 在诊断前和诊断后所有费用类别中都产生了更高的医疗保健费用。PwAD 对医疗保健的利用存在区域差异,这可能表明在获得医疗保健方面存在潜在差异。这些发现表明,更标准化和有针对性的诊断过程可能有助于降低成本和获得医疗保健的差异。

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