Ke Xuehua, Ding Helen, Sun Yezhou, Goto Daisuke, Waghmare Prajakta, Li Mingyue
Merck & Co., Inc, Rahway, NJ, USA.
College of Pharmacy, Purdue University, West Lafayette, IN, USA.
Curr Med Res Opin. 2025 Jan;41(1):173-184. doi: 10.1080/03007995.2024.2433252. Epub 2025 Jan 15.
Chronic cough (CC) symptoms can persist as refractory or unexplained CC (RCC). We sought to characterize the clinical and economic burden of RCC.
In this retrospective US cohort study using data from Optum's de-identified CDM Database (01/2015-03/2022), CC was identified as ≥1 CC diagnosis or ≥3 cough events (with ≥8 weeks and ≤120 days between the first and third events and ≥3 weeks between any two events). The index date was set as the earliest date of meeting the CC definition. The baseline period was defined as the 364 days prior to and including the index date. Adults with CC at baseline who met CC requirements (≥1 CC diagnosis, or ≥2 cough events occurring ≥8 weeks but ≤120 days apart) in both follow-up year 2 and follow-up year 3 were defined as having "3-year chronic cough" (3YCC), a proxy measure of RCC, and compared to adults with CC at baseline who did not meet CC requirements in follow-up years 2 and 3 (non-3YCC). A propensity score weighting approach was used to adjust for baseline differences between the 3YCC and non-3YCC groups to compare clinical characteristics and healthcare resource use and costs in the two groups during the follow-up period.
At baseline, the 3YCC group ( 3,338) had significantly more comorbidities and higher all-cause healthcare resource use and costs than the non-3YCC group ( 43,122) in unweighted analyses. After weighting, the groups ( 3,338 with 3YCC and 3,145 without) were compared during a 3-year follow-up period. The 3YCC group had significantly more comorbidities, higher levels of all-cause healthcare resource use, and higher all-cause healthcare costs during the follow-up period compared to the non-3YCC group, after adjusting for baseline differences. For example, the mean total healthcare costs (in 2022 US dollars) were significantly higher among the 3YCC group than the non-3YCC group in each follow-up year, at $49,454 versus $42,144 in follow-up year 1, $49,339 versus $36,939 in follow-up year 2, and $51,737 versus $36,503 in follow-up year 3 (.001 for each comparison).
After adjusting for baseline differences, persistent symptoms of CC were associated with significantly higher comorbidity, healthcare resource use, and healthcare costs compared to CC that resolved. Effective treatments for RCC would thus be expected to result in improved health as well as substantial healthcare cost offsets.
慢性咳嗽（CC）症状可能会持续存在，成为难治性或不明原因的慢性咳嗽（RCC）。我们试图描述RCC的临床和经济负担。
在这项回顾性美国队列研究中，使用了Optum的去识别化临床数据仓库数据库（2015年1月 - 2022年3月）的数据，CC被定义为≥1次CC诊断或≥3次咳嗽事件（第一次和第三次事件之间间隔≥8周且≤120天，任意两次事件之间间隔≥3周）。索引日期设定为符合CC定义的最早日期。基线期定义为索引日期及之前的364天。在随访第2年和第3年中，基线时患有CC且符合CC要求（≥1次CC诊断，或≥2次咳嗽事件，间隔≥8周但≤120天）的成年人被定义为患有“3年慢性咳嗽”（3YCC），这是RCC的一种替代指标，并与基线时患有CC但在随访第2年和第3年不符合CC要求的成年人（非3YCC）进行比较。采用倾向得分加权方法来调整3YCC组和非3YCC组之间的基线差异，以比较两组在随访期间的临床特征、医疗资源使用情况和成本。
在未加权分析中，基线时，3YCC组（n = 3338）比非3YCC组（n = 431,22）有更多的合并症，全因医疗资源使用和成本更高。加权后，在3年随访期内对两组（3338例3YCC患者和3145例非3YCC患者）进行比较。在调整基线差异后，与非3YCC组相比，3YCC组在随访期间有更多的合并症、更高水平的全因医疗资源使用和更高的全因医疗成本。例如，在各随访年中，3YCC组的平均总医疗成本（以2022年美元计）显著高于非3YCC组，随访第1年分别为49,454美元和42,144美元，随访第2年分别为49,339美元和36,939美元，随访第3年分别为51,737美元和36,503美元（每次比较P < 0.001）。
在调整基线差异后，与已缓解的CC相比，CC的持续症状与显著更高的合并症、医疗资源使用和医疗成本相关。因此，预计有效的RCC治疗将改善健康状况并大幅抵消医疗成本。
