PDF(Pubmed)
Abstract：
OBJECTIVE: This study aimed to estimate the extent of US health care resource use (HRU) and direct cost burden of cyclic vomiting syndrome (CVS).
UNASSIGNED: We selected patients in the MarketScan Commercial and Medicare Supplemental databases with ≥1 inpatient (IP) or ≥2 outpatient (OP) claims for CVS between October 1, 2015 and June 30, 2019, and continuous insurance enrollment for ≥12 months before (baseline) and ≥3 months after first CVS diagnosis (index). Using propensity scores based on baseline characteristics, each patient with CVS was matched to ∼3 non-CVS controls. We annualized HRU and costs to accommodate varying follow-up periods. Multivariable regressions further balanced CVS and non-CVS groups, and differences in HRU and costs between the matched cohorts were compared to quantify the direct cost burden of CVS.
UNASSIGNED: Patients with CVS incurred significantly higher average annualized HRU, with the largest differences in emergency room (1.9 vs 0.4) visits and hospital IP (0.9 vs 0.1) stays (P < .001). Patients with CVS had significantly higher annual total health care costs ($57,140 vs $14,912), with IP spending as the primary driver ($28,522 vs $3250) of the cost difference (all P < .001). After multivariable regression adjustments, total health care costs remained 4.1 times higher for patients with CVS relative to non-CVS controls, with IP costs 12.3 times higher, emergency room costs 5.8 times higher, OP visit costs 2.9 times higher, and OP pharmacy costs 1.5 times higher (all P < .001).
UNASSIGNED: Newly diagnosed patients with CVS have greater health care utilization and higher costs than matched non-CVS counterparts, suggesting substantial economic burden of CVS on the US health care system.
UNASSIGNED: We selected patients in the MarketScan Commercial and Medicare Supplemental databases with ≥1 inpatient (IP) or ≥2 outpatient (OP) claims for CVS between October 1, 2015 and June 30, 2019, and continuous insurance enrollment for ≥12 months before (baseline) and ≥3 months after first CVS diagnosis (index). Using propensity scores based on baseline characteristics, each patient with CVS was matched to ∼3 non-CVS controls. We annualized HRU and costs to accommodate varying follow-up periods. Multivariable regressions further balanced CVS and non-CVS groups, and differences in HRU and costs between the matched cohorts were compared to quantify the direct cost burden of CVS.
UNASSIGNED: Patients with CVS incurred significantly higher average annualized HRU, with the largest differences in emergency room (1.9 vs 0.4) visits and hospital IP (0.9 vs 0.1) stays (P < .001). Patients with CVS had significantly higher annual total health care costs ($57,140 vs $14,912), with IP spending as the primary driver ($28,522 vs $3250) of the cost difference (all P < .001). After multivariable regression adjustments, total health care costs remained 4.1 times higher for patients with CVS relative to non-CVS controls, with IP costs 12.3 times higher, emergency room costs 5.8 times higher, OP visit costs 2.9 times higher, and OP pharmacy costs 1.5 times higher (all P < .001).
UNASSIGNED: Newly diagnosed patients with CVS have greater health care utilization and higher costs than matched non-CVS counterparts, suggesting substantial economic burden of CVS on the US health care system.
摘要：
目的：本研究旨在评估美国卫生保健资源使用（HRU）的程度和周期性呕吐综合征（CVS）的直接成本负担。
我们在2015年10月1日至2019年6月30日期间选择了MarketScan商业和Medicare补充数据库中具有≥1例CVS住院(IP)或≥2例门诊(OP)索赔的患者，以及首次CVS诊断前(基线)≥12个月和首次CVS诊断后≥3个月(指数)的连续保险参保。使用基于基线特征的倾向评分，每位CVS患者与3名非CVS对照相匹配。我们按年度计算HRU和成本，以适应不同的随访期。多变量回归进一步平衡CVS和非CVS组，并比较了匹配队列之间HRU和成本的差异，以量化CVS的直接成本负担。
■CVS患者的平均年化HRU明显更高，在急诊室（1.9vs0.4）就诊和住院IP（0.9vs0.1）住院时间（P<.001）差异最大。CVS患者的年度总医疗保健费用明显更高（57,140美元对14,912美元），知识产权支出是成本差异的主要驱动因素(28,522美元对3250美元)(所有P<.001)。在多变量回归调整后，与非CVS对照相比，CVS患者的总医疗保健费用仍然高出4.1倍，IP成本高12.3倍，急诊室费用高5.8倍,OP访问费用高2.9倍，和OP药房费用高出1.5倍（所有P<.001）。
■新诊断的CVS患者比匹配的非CVS患者具有更高的医疗保健利用率和更高的成本，这表明CVS给美国医疗保健系统带来了巨大的经济负担。
我们在2015年10月1日至2019年6月30日期间选择了MarketScan商业和Medicare补充数据库中具有≥1例CVS住院(IP)或≥2例门诊(OP)索赔的患者，以及首次CVS诊断前(基线)≥12个月和首次CVS诊断后≥3个月(指数)的连续保险参保。使用基于基线特征的倾向评分，每位CVS患者与3名非CVS对照相匹配。我们按年度计算HRU和成本，以适应不同的随访期。多变量回归进一步平衡CVS和非CVS组，并比较了匹配队列之间HRU和成本的差异，以量化CVS的直接成本负担。
■CVS患者的平均年化HRU明显更高，在急诊室（1.9vs0.4）就诊和住院IP（0.9vs0.1）住院时间（P<.001）差异最大。CVS患者的年度总医疗保健费用明显更高（57,140美元对14,912美元），知识产权支出是成本差异的主要驱动因素(28,522美元对3250美元)(所有P<.001)。在多变量回归调整后，与非CVS对照相比，CVS患者的总医疗保健费用仍然高出4.1倍，IP成本高12.3倍，急诊室费用高5.8倍,OP访问费用高2.9倍，和OP药房费用高出1.5倍（所有P<.001）。
■新诊断的CVS患者比匹配的非CVS患者具有更高的医疗保健利用率和更高的成本，这表明CVS给美国医疗保健系统带来了巨大的经济负担。
