PDF(Pubmed)
Abstract：
OBJECTIVE: Population-based national data on the trends in expenditures related to coexisting atherosclerotic cardiovascular diseases (ASCVD) and diabetes is scarce. We assessed the trends in direct health care expenditures for ASCVD among individuals with and without diabetes, which can help to better define the burden of the co-occurrence of diabetes and ASCVD.
METHODS: We used 12-year data (2008-2019) from the US national Medical Expenditure Panel Survey including 28,144 U.S individuals aged ≥ 18 years. Using a two-part model (adjusting for demographics, comorbidities and time), we estimated mean and adjusted incremental medical expenditures by diabetes status among individuals with ASCVD. The costs were direct total health care expenditures (out-of-pocket payments and payments by private insurance, Medicaid, Medicare, and other sources) from various sources (office-based visits, hospital outpatient, emergency room, inpatient hospital, pharmacy, home health care, and other medical expenditures).
RESULTS: The total direct expenditures for individuals with ASCVD increased continuously by 30% from $14,713 (95% confidence interval (CI): $13,808-$15,619) in 2008-2009 to $19,145 (95% CI: $17,988-$20,301) in 2008-2019. Individuals with diabetes had a 1.5-fold higher mean expenditure that those without diabetes. A key driver of the observed increase in direct costs was prescription drug costs, which increased by 37% among all individuals with ASCVD. The increase in prescription drug costs was more pronounced among individuals with ASCVD and diabetes, in whom a 45% increase in costs was observed, from $5184 (95% CI: $4721-$5646) in 2008-2009 to $7501 (95% CI: $6678-$8325) in 2018-2019. Individuals with ASCVD and diabetes had $5563 (95% CI: $4643-$6483) higher direct incremental expenditures compared with those without diabetes, after adjusting for demographics and comorbidities. Among US adults with ASCVD, the estimated adjusted total direct excess medical expenditures were $42 billion per year among those with diabetes vs. those without diabetes.
CONCLUSIONS: In the setting of ASCVD, diabetes is associated with significantly increased health care costs, an increase that was driven by marked increase in medication costs.
METHODS: We used 12-year data (2008-2019) from the US national Medical Expenditure Panel Survey including 28,144 U.S individuals aged ≥ 18 years. Using a two-part model (adjusting for demographics, comorbidities and time), we estimated mean and adjusted incremental medical expenditures by diabetes status among individuals with ASCVD. The costs were direct total health care expenditures (out-of-pocket payments and payments by private insurance, Medicaid, Medicare, and other sources) from various sources (office-based visits, hospital outpatient, emergency room, inpatient hospital, pharmacy, home health care, and other medical expenditures).
RESULTS: The total direct expenditures for individuals with ASCVD increased continuously by 30% from $14,713 (95% confidence interval (CI): $13,808-$15,619) in 2008-2009 to $19,145 (95% CI: $17,988-$20,301) in 2008-2019. Individuals with diabetes had a 1.5-fold higher mean expenditure that those without diabetes. A key driver of the observed increase in direct costs was prescription drug costs, which increased by 37% among all individuals with ASCVD. The increase in prescription drug costs was more pronounced among individuals with ASCVD and diabetes, in whom a 45% increase in costs was observed, from $5184 (95% CI: $4721-$5646) in 2008-2009 to $7501 (95% CI: $6678-$8325) in 2018-2019. Individuals with ASCVD and diabetes had $5563 (95% CI: $4643-$6483) higher direct incremental expenditures compared with those without diabetes, after adjusting for demographics and comorbidities. Among US adults with ASCVD, the estimated adjusted total direct excess medical expenditures were $42 billion per year among those with diabetes vs. those without diabetes.
CONCLUSIONS: In the setting of ASCVD, diabetes is associated with significantly increased health care costs, an increase that was driven by marked increase in medication costs.
摘要：
目标：关于与动脉粥样硬化性心血管疾病（ASCVD）和糖尿病并存相关的支出趋势的基于人群的国家数据很少。我们评估了有和没有糖尿病的个体中ASCVD的直接医疗保健支出趋势，这可以帮助更好地定义糖尿病和ASCVD共同发生的负担。
方法：我们使用了美国国家医疗支出小组调查的12年数据（2008-2019年），包括28,144名年龄≥18岁的美国人。使用两部分模型(根据人口统计进行调整，合并症和时间)，我们估算了ASCVD患者中按糖尿病状态划分的平均和调整医疗支出增量.费用是直接的医疗保健总支出(自付费用和私人保险支付，医疗补助,Medicare,和其他来源)来自各种来源(基于办公室的访问，医院门诊,急诊室,住院医院,药房,家庭保健,和其他医疗支出)。
结果：患有ASCVD的个人的总直接支出从2008-2009年的$14,713（95％置信区间（CI）：$13,808-$15,619）连续增加30％，至$19,145（95％CI：$17,988-$20,301）在2008-2019年。糖尿病患者的平均支出是没有糖尿病患者的1.5倍。观察到的直接成本增加的一个关键驱动因素是处方药成本，在所有ASCVD患者中增加了37%。在ASCVD和糖尿病患者中，处方药成本的增加更为明显，观察到成本增加了45%，从2008-2009年的5184美元（95%CI：4721-5646美元）到2018-2019年的7501美元（95%CI：6678-8325美元）。与没有糖尿病的人相比，患有ASCVD和糖尿病的人有5563美元(95%CI:4643-6483美元)更高的直接增量支出。在调整人口统计学和合并症后。在患有ASCVD的美国成年人中，据估计，在糖尿病患者中，调整后的直接超额医疗支出总额为每年420亿美元。那些没有糖尿病的人。
结论：在ASCVD的设置中，糖尿病与显著增加的医疗费用有关，由药物费用的显著增加推动的增长。
方法：我们使用了美国国家医疗支出小组调查的12年数据（2008-2019年），包括28,144名年龄≥18岁的美国人。使用两部分模型(根据人口统计进行调整，合并症和时间)，我们估算了ASCVD患者中按糖尿病状态划分的平均和调整医疗支出增量.费用是直接的医疗保健总支出(自付费用和私人保险支付，医疗补助,Medicare,和其他来源)来自各种来源(基于办公室的访问，医院门诊,急诊室,住院医院,药房,家庭保健,和其他医疗支出)。
结果：患有ASCVD的个人的总直接支出从2008-2009年的$14,713（95％置信区间（CI）：$13,808-$15,619）连续增加30％，至$19,145（95％CI：$17,988-$20,301）在2008-2019年。糖尿病患者的平均支出是没有糖尿病患者的1.5倍。观察到的直接成本增加的一个关键驱动因素是处方药成本，在所有ASCVD患者中增加了37%。在ASCVD和糖尿病患者中，处方药成本的增加更为明显，观察到成本增加了45%，从2008-2009年的5184美元（95%CI：4721-5646美元）到2018-2019年的7501美元（95%CI：6678-8325美元）。与没有糖尿病的人相比，患有ASCVD和糖尿病的人有5563美元(95%CI:4643-6483美元)更高的直接增量支出。在调整人口统计学和合并症后。在患有ASCVD的美国成年人中，据估计，在糖尿病患者中，调整后的直接超额医疗支出总额为每年420亿美元。那些没有糖尿病的人。
结论：在ASCVD的设置中，糖尿病与显著增加的医疗费用有关，由药物费用的显著增加推动的增长。
