Division of Gastroenterology, University of California, San Diego, CA, USA.
Gastroenterology Section, VA San Diego Healthcare System, San Diego, CA, USA.
J Med Econ. 2023 Jan-Dec;26(1):1227-1236. doi: 10.1080/13696998.2023.2263252. Epub 2023 Oct 9.
The study objectives were to 1) characterize the cost drivers of patients with (HP) and 2) estimate HP-related cost savings following lab-confirmed HP eradication with US guideline-recommended treatment compared to failed eradication.
We identified adults newly diagnosed with HP between 1/1/2016-12/31/2019 in the Veradigm Electronic Health Record Database linked to claims data (earliest HP diagnosis = index date). For the overall costs analysis, we required patients to have data available for ≥12 months before and after the index date. Then, we used multivariable modeling to assess the marginal effects of comorbidities on all cause-healthcare costs in the 12 months following HP diagnosis. For the eradication savings analysis, we identified patients with ≥1 HP eradication regimen, a subsequent HP lab test result, and ≥1 year of data after the test result. Then we used multivariable modeling to estimate HP-related cost while adjusting for eradication status, demographics, post-testing HP-related clinical variables, and the interactions between eradication status and each HP-related clinical variable.
The overall cost analysis included 60,593 patients with HP (mean age 54.2 years, 65.5% female). Mean (SD) 12-month unadjusted all-cause costs were $23,693 ($78,089). Rare comorbidities demonstrated the highest marginal effect. The marginal effects of gastric cancer and PUD were $15,705 and $7,323, respectively. In the eradication savings analysis, 1,835 (80.0%) of the 2295 patients had lab test-confirmed HP eradication. Compared to failed eradication, there were significant one-year cost savings among patients with successful HP eradication and select conditions: $1,770 for PUD, $518 for atrophic gastritis, $494 for functional dyspepsia, and $352 for gastritis.
The healthcare costs of patients with HP are partially confounded by their burden of high-cost comorbidities. In the subset of patients with available results, confirmed vs. failed eradication of HP was associated with short-term cost offsets among those with specific to HP-related sequelae.
本研究的目的是：1）描述（HP）患者的成本驱动因素；2）与根除失败相比，用美国指南推荐的治疗方法对实验室确诊的 HP 进行根除后，估计与 HP 相关的成本节约。
我们在 Veradigm 电子病历数据库中识别出 2016 年 1 月 1 日至 2019 年 12 月 31 日期间新诊断为 HP 的成年人，该数据库与索赔数据相关联（最早的 HP 诊断=索引日期）。对于总成本分析，我们要求患者在索引日期前和后至少有 12 个月的数据可用。然后，我们使用多变量模型评估合并症对 HP 诊断后 12 个月内所有原因医疗保健成本的边际效应。对于根除节约分析，我们确定了≥1 种 HP 根除方案、随后的 HP 实验室检测结果和检测结果后≥1 年数据的患者。然后，我们使用多变量模型估计与 HP 相关的成本，同时调整根除状态、人口统计学、检测后与 HP 相关的临床变量以及根除状态与每个与 HP 相关的临床变量之间的相互作用。
总体成本分析包括 60593 例 HP 患者（平均年龄 54.2 岁，65.5%为女性）。未经调整的 12 个月全因费用平均为 23693 美元（78089 美元）。罕见合并症显示出最高的边际效应。胃癌和 PUD 的边际效应分别为 15705 美元和 7323 美元。在根除节约分析中，2295 例患者中的 1835 例（80.0%）进行了实验室检测确认的 HP 根除。与根除失败相比，成功根除 HP 的患者在某些情况下有显著的一年成本节约：消化性溃疡（PUD）节约 1770 美元，萎缩性胃炎节约 518 美元，功能性消化不良节约 494 美元，胃炎节约 352 美元。
HP 患者的医疗保健成本部分受到其高成本合并症负担的影响。在有可用结果的患者亚组中，与 HP 相关的特定后遗症相比，确认与未确认的 HP 根除与短期成本抵消相关。
