Department of Internal Medicine, University of Michigan, Ann Arbor, Mich.
Division of Allergy and Clinical Immunology, University of Michigan, Ann Arbor, Mich.
J Allergy Clin Immunol Pract. 2023 Aug;11(8):2432-2438.e1. doi: 10.1016/j.jaip.2023.03.006. Epub 2023 Apr 21.
Hereditary angioedema (HAE) is a rare and potentially fatal genetic disease associated with recurrent and unpredictable episodes of angioedema. Although modern therapies have dramatically increased quality of life, insurance changes, delays, and denials are becoming more common.
To examine the impact of insurance delays and denials on patient health and well-being.
A total of 20 patients with HAE (type 1 and 2) who recently experienced insurance delays or denials completed an online survey, and 19 participated in a follow-up focus group. The survey and focus group addressed the impact of insurance challenges on the use of health care services, work/school attendance, and anxiety. Three independent reviewers coded each focus group transcript using a thematic saturation approach.
A total of 70% of participants reported an increased frequency of angioedema attacks resulting from insurance delays or denials. More than 50% missed work/school days because of increased attacks, and 90% reported greater anxiety. Twenty-five percent of respondents reported more urgent care or emergency department visits. In focus groups, participants identified specific ways that losing access to medication had a negative impact on their health, family, and work/school life. Insufficient notification of health insurance policy changes and the time and effort required to regain access to medications compounded patients' frustration and anxiety.
Insurance delays and denials have significant impacts on individuals with HAE including (1) increased urgent care and emergency department visits, (2) missed work/school days, (3) higher levels of anxiety, and (4) a negative impact on family life.
遗传性血管性水肿（HAE）是一种罕见的、潜在致命的遗传性疾病，与复发性、不可预测的血管性水肿发作有关。尽管现代疗法极大地提高了生活质量，但保险变更、延迟和拒绝越来越常见。
检查保险延迟和拒绝对患者健康和福祉的影响。
最近经历过保险延迟或拒绝的 20 名 HAE（1 型和 2 型）患者完成了在线调查，其中 19 名参加了后续焦点小组。调查和焦点小组探讨了保险挑战对医疗服务使用、工作/上学出勤率和焦虑的影响。三位独立评审员使用主题饱和方法对每个焦点小组的记录进行了编码。
共有 70%的参与者报告称，由于保险延迟或拒绝，血管性水肿发作的频率增加。超过 50%的人因发作增加而缺勤，90%的人报告焦虑程度增加。25%的受访者报告称，他们更多地去了急诊或急诊室就诊。在焦点小组中，参与者确定了失去药物治疗机会对他们的健康、家庭和工作/上学生活产生负面影响的具体方式。对健康保险政策变更通知不足，以及重新获得药物治疗所需的时间和精力，加剧了患者的沮丧和焦虑。
保险延迟和拒绝对 HAE 患者有重大影响，包括（1）急诊和急诊就诊增加，（2）缺勤，（3）焦虑程度更高，（4）对家庭生活的负面影响。
