Shen Shih-Pei, Herr Keira Joann, Liu Yanfang, Yang Chih-Chao, Tang Chao-Hsiun
School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan.
Janssen Medical Affairs Asia Pacific, Singapore, Singapore.
Front Neurol. 2023 Jul 26;14:1216595. doi: 10.3389/fneur.2023.1216595. eCollection 2023.
We estimated healthcare resource utilization (HRU) and costs in patients with generalized myasthenia gravis (gMG) in Taiwan.
This retrospective population-based, matched cohort study used the National Health Insurance Research Database to identify prevalent patients with gMG (cases) in 2019. In total, 2537 cases were matched (1:4) by age, sex, and urbanization level to 10148 randomly selected patients without gMG (comparators). A generalized linear regression model predicted the frequency of HRU and costs among service users. Costs attributable to gMG were obtained by subtracting all-cause HRU costs incurred by comparators from cases.
The mean age of all patients was 54.99 years and 55.97% were female. Compared with comparators, cases had significantly higher rates of hypertension (33.03%/24.26%), diabetes mellitus (18.92%/11.37%), malignancies (16.00%/4.08%), cardiovascular disease (11.35%/8.12%), thyroid-related conditions (5.99%/1.16%), respiratory illness/disorders (4.38%/1.22%), and neurotic disorders (4.65%/2.6%). Amongst users of healthcare resources, cases had a mean 10 additional outpatient visits, 0.62 inpatient stays, and 0.49 emergency room visits in 2019 compared with comparators ( < 0.0001 for all). The mean (standard deviation) difference in all-cause healthcare costs between cases and comparators was NT$ 94997 (76431) [US$ 3133 (2521)], and was significantly higher for all categories (outpatient, inpatient, emergency room, drugs; < 0.0001 for all). Among employed persons, 13.18%/7.59% of cases/comparators changed employment status during the study ( < 0.0001).
gMG presents a substantial burden on HRU and healthcare costs in Taiwan. A high attrition rate from full-time employment suggests additional societal costs. Improved treatments are needed to alleviate the burden of disease on individuals, healthcare systems, and economies.
我们估算了台湾地区全身型重症肌无力（gMG）患者的医疗资源利用（HRU）情况及费用。
这项基于人群的回顾性匹配队列研究利用全民健康保险研究数据库，确定了2019年gMG的现患患者（病例组）。总共2537例病例按照年龄、性别和城市化水平以1:4的比例与10148例随机选取的无gMG患者（对照组）进行匹配。广义线性回归模型预测了服务使用者中HRU的频率和费用。gMG所致费用通过用病例组的全因HRU费用减去对照组的全因HRU费用得出。
所有患者的平均年龄为54.99岁，女性占55.97%。与对照组相比，病例组高血压（33.03%/24.26%）、糖尿病（18.92%/11.37%）、恶性肿瘤（16.00%/4.08%）、心血管疾病（11.35%/8.12%）、甲状腺相关疾病（5.99%/1.16%）、呼吸道疾病/障碍（4.38%/1.22%）和神经症（4.65%/2.6%）的发生率显著更高。在医疗资源使用者中，2019年病例组与对照组相比，平均门诊就诊次数多10次，住院0.62次，急诊就诊0.49次（所有P均<0.0001）。病例组和对照组全因医疗费用的平均（标准差）差值为新台币94997（76431）元[3133（2521）美元]，所有类别（门诊、住院、急诊、药品；所有P均<0.0001）均显著更高。在就业人员中，病例组/对照组有13.18%/7.59%在研究期间改变了就业状态（P<0.0001）。
在台湾地区，gMG给HRU和医疗费用带来了沉重负担。全职工作的高流失率表明存在额外的社会成本。需要改进治疗方法以减轻疾病对个人、医疗系统和经济的负担。
