重症哮喘患者多发合并疾病的经济负担：一项基于人群的为期20年的研究
2019/10/17
摘要
背景：重症或难治哮喘患者多发病情况对经济影响尚未得到全面调查。
目的：与非重症哮喘和非哮喘患者相比，评估重度哮喘患者并存慢性病（合并症）所致的医疗费用增加。
方法：使用加拿大不列颠哥伦比亚的卫生行政数据（1996-2016），根据药物使用的强度和加重次数，确定在事件年份重症哮喘发作的患者。同时在随访过程中建立非哮喘诊断的配对个体和轻度/潜伏或中度哮喘（非重症哮喘）人群的匹配队列。根据国际疾病分类将随访期间的卫生服务使用记录分为16个主要疾病类别。估计增量费用（2016年加元为1加元= 0.75美元= 0.56欧元= 0.68欧元）被定义为重度哮喘患者与非重度哮喘和非哮喘患者之间医疗费用的调整差额。
结果：与非哮喘患者相比，重症哮喘患者的额外成本为每人每年2779$（95％CI 2514至3045），其中54％（1508$）归因于合并症。相对于非重症哮喘患者，重症哮喘与每人每年1922$的增量成本相关（95％CI 1670至2174），其中52％（1003$）归因于合并症。在这两种情况下，成本最高的合并症是哮喘以外的呼吸系统疾病（分别为468$（17％）和451$（23％））。
结论：合并症占重度哮喘患者附加医疗费用的一半以上。这突显了在重症哮喘患者进行循证决策时，考虑多发合并疾病经济负担的重要性。
Economic burden of multimorbidity in patients with severe asthma: a 20-year population-based study.
Chen W, Safari A, FitzGerald JM, Sin DD, Tavakoli H, Sadatsafavi M.
Abstract
BACKGROUND:The economic impact of multimorbidity in severe or difficult-to-treat asthma has not been comprehensively investigated.
AIMS: To estimate the incremental healthcare costs of coexisting chronic conditions (comorbidities) in patients with severe asthma, compared with non-severe asthma and no asthma.
METHODS: Using health administrative data in British Columbia, Canada (1996-2016), we identified, based on the intensity of drug use and occurrence of exacerbations, individuals who experienced severe asthma in an incident year. We also constructed matched cohorts of individuals without an asthma diagnosis and those who had mild/dormant or moderate asthma (non-severe asthma) throughout their follow-up. Health service use records during follow-up were categorized into 16 major disease categories based on the International Classification of Diseases.Incremental costs (in 2016 Canadian Dollars, CAD$1=US$0.75=₤0.56=€0.68) were estimated as the adjusted difference in healthcare costs between individuals with severe asthma compared with those with non-severe asthma and non-asthma.
RESULTS: Relative to no asthma, incremental costs of severe asthma were $2779 per person-year (95% CI 2514 to 3045), with 54% ($1508) being attributed to comorbidities. Relative to non-severe asthma, severe asthma was associated with incremental costs of $1922 per person-year (95% CI 1670 to 2174), with 52% ($1003) being attributed to comorbidities. In both cases, the most costly comorbidity was respiratory conditions other than asthma ($468 (17%) and $451(23%), respectively).
CONCLUSIONS: Comorbidities accounted for more than half of the incremental medical costs in patients with severe asthma. This highlights the importance of considering the burden of multimorbidity in evidence-informed decision making for patients with severe asthma.
背景：重症或难治哮喘患者多发病情况对经济影响尚未得到全面调查。
目的：与非重症哮喘和非哮喘患者相比，评估重度哮喘患者并存慢性病（合并症）所致的医疗费用增加。
方法：使用加拿大不列颠哥伦比亚的卫生行政数据（1996-2016），根据药物使用的强度和加重次数，确定在事件年份重症哮喘发作的患者。同时在随访过程中建立非哮喘诊断的配对个体和轻度/潜伏或中度哮喘（非重症哮喘）人群的匹配队列。根据国际疾病分类将随访期间的卫生服务使用记录分为16个主要疾病类别。估计增量费用（2016年加元为1加元= 0.75美元= 0.56欧元= 0.68欧元）被定义为重度哮喘患者与非重度哮喘和非哮喘患者之间医疗费用的调整差额。
结果：与非哮喘患者相比，重症哮喘患者的额外成本为每人每年2779$（95％CI 2514至3045），其中54％（1508$）归因于合并症。相对于非重症哮喘患者，重症哮喘与每人每年1922$的增量成本相关（95％CI 1670至2174），其中52％（1003$）归因于合并症。在这两种情况下，成本最高的合并症是哮喘以外的呼吸系统疾病（分别为468$（17％）和451$（23％））。
结论：合并症占重度哮喘患者附加医疗费用的一半以上。这突显了在重症哮喘患者进行循证决策时，考虑多发合并疾病经济负担的重要性。
（中日友好医院呼吸与危重症医学科 张鑫 摘译 林江涛 审校）
（Thorax. 2019 Sep 18. pii: thoraxjnl-2019-213223. doi:10.1136/thoraxjnl-2019-213223.）
（Thorax. 2019 Sep 18. pii: thoraxjnl-2019-213223. doi:10.1136/thoraxjnl-2019-213223.）
Economic burden of multimorbidity in patients with severe asthma: a 20-year population-based study.
Chen W, Safari A, FitzGerald JM, Sin DD, Tavakoli H, Sadatsafavi M.
Abstract
BACKGROUND:The economic impact of multimorbidity in severe or difficult-to-treat asthma has not been comprehensively investigated.
AIMS: To estimate the incremental healthcare costs of coexisting chronic conditions (comorbidities) in patients with severe asthma, compared with non-severe asthma and no asthma.
METHODS: Using health administrative data in British Columbia, Canada (1996-2016), we identified, based on the intensity of drug use and occurrence of exacerbations, individuals who experienced severe asthma in an incident year. We also constructed matched cohorts of individuals without an asthma diagnosis and those who had mild/dormant or moderate asthma (non-severe asthma) throughout their follow-up. Health service use records during follow-up were categorized into 16 major disease categories based on the International Classification of Diseases.Incremental costs (in 2016 Canadian Dollars, CAD$1=US$0.75=₤0.56=€0.68) were estimated as the adjusted difference in healthcare costs between individuals with severe asthma compared with those with non-severe asthma and non-asthma.
RESULTS: Relative to no asthma, incremental costs of severe asthma were $2779 per person-year (95% CI 2514 to 3045), with 54% ($1508) being attributed to comorbidities. Relative to non-severe asthma, severe asthma was associated with incremental costs of $1922 per person-year (95% CI 1670 to 2174), with 52% ($1003) being attributed to comorbidities. In both cases, the most costly comorbidity was respiratory conditions other than asthma ($468 (17%) and $451(23%), respectively).
CONCLUSIONS: Comorbidities accounted for more than half of the incremental medical costs in patients with severe asthma. This highlights the importance of considering the burden of multimorbidity in evidence-informed decision making for patients with severe asthma.
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估计的心室大小，哮喘严重程度和急性发作：SARP III队列
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重症哮喘患者长期使用阿奇霉素可降低流感嗜血杆菌的发病率、增加抗生素耐药性
