Adjei Naomi N, Haas Allen, Sun Charlotte C, Zhao Hui, Yeh Paul G, Giordano Sharon H, Toumazis Iakovos, Meyer Larissa A
Division of Surgery, Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Division of Cancer Prevention and Population Sciences, Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Value Health. 2025 Feb;28(2):206-214. doi: 10.1016/j.jval.2024.10.3847. Epub 2024 Nov 10.
Current, real-world healthcare cost information is needed to project future expenditures and inform policy. We estimated the healthcare costs for adults in 2019 in the United States by age, sex, race/ethnicity, geographic region, and comorbidity.
We aggregated and summarized the healthcare costs in 2021 US dollars using claims data derived from Optum's deidentified Clinformatics® Data Mart Database, which includes inpatient, outpatient, and prescription claims for commercial and Medicare Advantage beneficiaries nationwide.
A total of 9 227 901 adults were included in the analysis. The largest group represented was 71 to 75 years old (13%), female (53%), White (68%), received care in the South (41%), and had commercial health insurance (56%). There was a positive relationship between healthcare cost and age. Females had a 1.3-fold multiplicative increase in costs than males (95% CI 1.33-1.34). There were 92.5% of individuals who had health claims in the Northeast, 89.6% in the Midwest, 88.9% in the South, 77.1% in the West, and 12.7% with unknown geographic region. Patients with severe renal failure, heart failure, or metastatic cancer incurred the highest mean yearly costs ($139 844, $113 031, and $85 299, respectively). Metastatic cancer and severe renal failure were associated with a 5.3-fold multiplicative increase in costs than not having these conditions, after adjusting for potential confounders (95% CI 5.26-5.41 and 4.98-5.16, respectively).
We identified patient characteristics and medical conditions that are associated with high healthcare cost burden and could benefit from tailored interventions. We provided detailed cost estimates to aid healthcare modeling, cost projection, and cost-minimizing interventions.
需要当前真实世界的医疗保健成本信息来预测未来支出并为政策提供依据。我们按年龄、性别、种族/族裔、地理区域和合并症估算了2019年美国成年人的医疗保健成本。
我们使用从Optum的去识别化临床信息学数据集市数据库获得的索赔数据，以2021年美元汇总并总结了医疗保健成本，该数据库包括全国商业和医疗保险优势受益人的住院、门诊和处方索赔。
共有9227901名成年人纳入分析。最大的群体是71至75岁（13%）、女性（53%）、白人（68%）、在南部接受治疗（41%）且拥有商业健康保险（56%）。医疗保健成本与年龄呈正相关。女性的成本比男性增加了1.3倍（95%置信区间1.33 - 1.34）。东北地区有健康索赔的个体占92.5%，中西部地区为89.6%，南部地区为88.9%，西部地区为77.1%，地理区域未知的为12.7%。严重肾衰竭、心力衰竭或转移性癌症患者的年平均成本最高（分别为139844美元、113031美元和85299美元）。在调整潜在混杂因素后，转移性癌症和严重肾衰竭与无这些疾病相比，成本增加了5.3倍（95%置信区间分别为5.26 - 5.41和4.98 - 5.16）。
我们确定了与高医疗保健成本负担相关且可从量身定制的干预措施中受益的患者特征和医疗状况。我们提供了详细的成本估算，以帮助进行医疗保健建模、成本预测和成本最小化干预措施。
