重度哮喘患者共患病的经济负担:一项20年的基于人群的研究
2020/01/07
摘要
背景：共患病对重症哮喘或难治性哮喘的经济影响尚未得到全面的研究。
目的：评估重症哮喘、非重症哮喘和无哮喘患者共存慢性疾病（共患病）的医疗护理话费的增量。
方法：利用加拿大不列颠哥伦比亚省(1996-2016年)的卫生行政数据，我们根据药物使用强度和急性加重的发生，确定了在某一事件年经历重症哮喘的个体。我们还建立了没有哮喘诊断的个体和在整个随访中有轻度/隐匿性或中度哮喘(非重症哮喘)的个体的匹配队列。根据国际疾病分类，随访期间的卫生服务使用记录被分为16个主要疾病类别。增量成本(以2016年加元计算，CAD$1=US$0.75= 0.56=€0.68)被估计为重症哮喘患者与非重症哮喘患者和非哮喘患者之间医疗成本的调整差异。
结果：与无哮喘患者相比，重症哮喘患者每年增加费用为2779美元(95% CI 2514 - 3045)，其中54%(1508美元)为共患病。与非严重哮喘相比，严重哮喘与每年增加1922美元的费用有关(95% CI 1670 - 2174)，其中52%(1003美元)是由共患病引起的。在这两种情况下，最昂贵的合并症是除哮喘之外的呼吸系统疾病(分别为468美元(17%)和451美元(23%))。
结论：合并疾病占重症哮喘患者增加的医疗费用的一半以上。这强调了在有证据支持的决策中考虑共患病负担对重症哮喘患者的重要性。
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 categorised 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：共患病对重症哮喘或难治性哮喘的经济影响尚未得到全面的研究。
目的：评估重症哮喘、非重症哮喘和无哮喘患者共存慢性疾病（共患病）的医疗护理话费的增量。
方法：利用加拿大不列颠哥伦比亚省(1996-2016年)的卫生行政数据，我们根据药物使用强度和急性加重的发生，确定了在某一事件年经历重症哮喘的个体。我们还建立了没有哮喘诊断的个体和在整个随访中有轻度/隐匿性或中度哮喘(非重症哮喘)的个体的匹配队列。根据国际疾病分类，随访期间的卫生服务使用记录被分为16个主要疾病类别。增量成本(以2016年加元计算，CAD$1=US$0.75= 0.56=€0.68)被估计为重症哮喘患者与非重症哮喘患者和非哮喘患者之间医疗成本的调整差异。
结果：与无哮喘患者相比，重症哮喘患者每年增加费用为2779美元(95% CI 2514 - 3045)，其中54%(1508美元)为共患病。与非严重哮喘相比，严重哮喘与每年增加1922美元的费用有关(95% CI 1670 - 2174)，其中52%(1003美元)是由共患病引起的。在这两种情况下，最昂贵的合并症是除哮喘之外的呼吸系统疾病(分别为468美元(17%)和451美元(23%))。
结论：合并疾病占重症哮喘患者增加的医疗费用的一半以上。这强调了在有证据支持的决策中考虑共患病负担对重症哮喘患者的重要性。
(中日友好医院呼吸与危重症医学科 张清 摘译 林江涛 审校)
(Thorax. 2019 Dec;74(12):1113-1119. doi: 10.1136/thoraxjnl-2019-213223)
(Thorax. 2019 Dec;74(12):1113-1119. 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 categorised 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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