识别和表征商业保险患者的HFpEF与高与低的医疗保健资源利用率
Jacob Earl1, Laura A Hart1,2, Ryan N Hansen1
1The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, Department of Pharmacy, University of Washington, Seattle.
Journal of managed care & specialty pharmacy
|July 24, 2025
概括
高昂的医疗保健成本和资源利用在心力衰竭中与保存的喷射分数 (HFpEF) 与特定的并发症有关. 早期诊断和管理对于减少患者负担和医疗保健支出至关重要.
科学领域:
- 心脏病学 心脏病学
- 卫生经济学 卫生经济学
- 公共卫生 公共卫生
背景情况:
- 保存喷射分数 (HFpEF) 的心力衰竭占所有心力衰竭诊断的一半,构成了重大的公共卫生挑战.
- 尽管取得了进展,但HFpEF导致了大量的医疗保健资源利用 (HCRU) 和相关成本.
- 在HFpEF中描述HCRU和成本对于确定成本驱动因素和潜在干预措施至关重要.
研究的目的:
- 分析HFpEF患者的医疗保健资源利用率和成本,比较最高 (第90百分位数) 和最低 (第10百分位数) 的成本组.
- 确定与属于高成本 (第90百分位) 群体相关的因素.
- 检查HCRU的趋势和成本随着时间的推移.
主要方法:
- 使用Merative MarketScan数据库 (2014-2021) 对具有HFpEF的商业保险成年人的回顾性队列研究.
- 使用考克斯比例危险模型和卡普兰-梅尔技术估计HCRU和成本.
- 多变量物流回归用于识别高HCRU和成本的预测因素.
主要成果:
- 第90百分位组的年HCRU显著增加,包括13次额外的ED/紧急护理访问,3次住院住院和30天住院.
- 第90个百分点的总医疗费用平均比第10个百分点高378880美元.
- 第90百分位的关键预测因素包括女性性别,较高的查尔森并发症指数 (CCI) 分数 (≥2),心房动,循环利尿剂的使用,以及特定药物,如ARNI和SGLT2抑制剂.
结论:
- 在高成本和低成本的HFpEF患者群体之间存在HCRU和成本的显著差异.
- 两组在诊断后的第一个月经历了峰值利用,从2014年到2022年,总体成本保持稳定.
- 制定预防HFpEF发病和管理并发病的策略对于减少医疗保健支出至关重要.
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