背景:这项研究量化了各种事件并发症的纵向经济负担,代谢综合征(MS)相关危险因素,和MS患者的合并症。
方法:这项回顾性研究利用了来自2013年国家健康访谈调查和2012-2021年国家健康保险研究数据库的相关数据来识别MS个体及其特征。每个并发症的发生率计算为研究期间并发症事件的数量除以随访期间的总人年。使用广义估计方程模型分析并发症的医疗成本,以确定调整患者特征后并发症的成本影响。对高缺失率变量的敏感性分析(即,死因,进行体重指数)。
结果:在经过8.28(±1.35)年随访的837名MS患者中,最常见的并发症是微血管疾病(肾病/视网膜病变/神经病的发生率:6.49/2.64/2.08事件/100人年),其次是心血管疾病(2.47),外周血管疾病(2.01),和癌症(1.53)。死亡是最昂贵的事件(人均事件年费用:16,429美元),癌症是最昂贵的并发症(非MS和MS相关癌症9,127-11,083美元)。发展非MS/MS相关癌症,心血管疾病,与肥胖相关的医疗条件使年度成本增加了273%(95%CI:181-397%)/175%(105-269%),159%(118-207%),和140%(84-214%),分别。微血管疾病对年度成本的影响最低(即,肾病/神经病变/视网膜病变增加27%[17-39%]/27%[11-46%]/24%[11-37%],分别)。现有的合并症使每年的成本增加了20%(骨关节炎)至108%(抑郁症)。患有病态肥胖(即,体重指数≥35kg/m2)增加了58%(30-91%)的年度成本。
结论:昂贵的事故并发症带来的经济负担(即,心血管疾病,外周血管疾病,癌症),MS相关风险因素(即病态肥胖),和合并症(即,抑郁症)强调了早期干预以预防MS及其进展的迫切需要。本研究报告的综合成本估算可以促进经济分析的参数化,以确定针对这些患者的具有成本效益的干预措施。
BACKGROUND: This study quantifies the longitudinal economic burden for a wide spectrum of incident complications, metabolic syndrome (MS)-related risk factors, and comorbidities in patients with MS.
METHODS: This retrospective study utilized linked data from the 2013 National Health Interview Survey and the 2012-2021 National Health Insurance Research Database to identify MS individuals and their characteristics. The incidence rate of each complication was calculated as the number of complication events in the study period divided by the total person-years during follow-up. The healthcare costs of complications were analyzed using a generalized estimating equation model to determine the cost impact of complications after adjustment for patients\' characteristics. Sensitivity analyses on variables with high missing rates (i.e., cause of death, body mass index) were performed.
RESULTS: Among 837 identified MS individuals over 8.28 (± 1.35) years of follow-up, the most frequent complications were microvascular diseases (incidence rate for nephropathy/retinopathy/neuropathy: 6.49/2.64/2.08 events per 100 person-years), followed by cardiovascular diseases (2.47), peripheral vascular diseases (2.01), and cancers (1.53). Death was the costliest event (event-year cost per person: USD 16,429) and cancers were the most expensive complications (USD 9,127-11,083 for non-MS- and MS-related cancers). Developing non-MS/MS-related cancers, cardiovascular diseases, and obesity-related medical conditions increased annual costs by 273% (95% CI: 181-397%)/175% (105-269%), 159% (118-207%), and 140% (84-214%), respectively. Microvascular diseases had the lowest cost impact on annual costs (i.e., 27% [17-39%]/27% [11-46%]/24% [11-37%] increases for nephropathy/neuropathy/retinopathy, respectively). Having existing comorbidities increased annual costs by 20% (osteoarthritis) to 108% (depression). Having morbid obesity (i.e., body mass index ≥ 35 kg/m2) increased annual costs by 58% (30-91%).
CONCLUSIONS: The economic burden from costly incident complications (i.e., cardiovascular diseases, peripheral vascular diseases, cancers), MS-related risk factors (i.e., morbid obesity), and comorbidities (i.e., depression) highlight the urgent need for early intervention to prevent MS and its progression. The comprehensive cost estimates reported in this study can facilitate the parameterization of economic analyses to identify cost-effective interventions for these patients.