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瑞士炎症性肠病住院患者年度健康资源利用及成本的系统分析。

Systematic analysis of annual health resource utilization and costs in hospitalized patients with inflammatory bowel disease in Switzerland.

作者信息

Schoepfer Alain, Vavricka Stephan R, Brüngger Beat, Reich Oliver, Blozik Eva, Bähler Caroline

机构信息

Division of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois.

University of Lausanne, Lausanne.

出版信息

Eur J Gastroenterol Hepatol. 2018 Aug;30(8):868-875. doi: 10.1097/MEG.0000000000001160.

Abstract

BACKGROUND AND AIMS

Real-life data on health resource utilization and costs of hospitalized patients with inflammatory bowel disease are lacking in Switzerland. We aimed to assess health resource utilization and costs during a 1-year follow-up period starting with an index hospitalization.

PATIENTS AND METHODS

On the basis of claims data of the Helsana health insurance group, health resource utilization was assessed and costs reimbursed by mandatory basic health insurance [in Swiss Francs (CHF); 1 CHF=0.991 US$] were calculated during a 1-year follow-up period starting with an index hospitalization in the time period between 1 January 2013 and 31 December 2014.

RESULTS

Of 202 002 patients with at least one hospitalization in 2013-2014, a total of 270 (0.13%) patients had inflammatory bowel disease as main diagnosis [112 (41.5%) ulcerative colitis (UC), 158 (58.5%) Crohn's disease (CD), 154/270 (57.0%) females]. In comparison with patients with UC, patients with CD were significantly more frequently treated with biologics (45.6 vs. 20.5%, P<0.001) and more frequently underwent surgery during index hospitalization (27.8 vs. 9.8%, P=0.002). Compared with patients with UC, those with CD had significantly more consultations [odds ratio (OR): 1.06, 95% confidence interval (CI): 1.01-1.12, P=0.016], higher median annual total costs (OR: 1.25, 95% CI: 1.05-1.48, P=0.012), and higher outpatient costs (OR: 1.33, 95% CI: 1.07-1.66, P=0.011). In the bivariate model, median total costs for patients with CD and those with UC were 24 270 and 17 270 CHF, respectively (P=0.032).

CONCLUSION

When compared with patients with UC, hospitalized patients with CD have during a 1-year follow-up a higher rate of outpatient consultations and generate higher costs.

摘要

背景与目的

瑞士缺乏关于炎症性肠病住院患者健康资源利用及成本的实际数据。我们旨在评估从首次住院开始的1年随访期内的健康资源利用情况及成本。

患者与方法

基于赫尔萨纳健康保险集团的理赔数据,在2013年1月1日至2014年12月31日期间,从首次住院开始计算1年随访期内的健康资源利用情况,并计算强制性基本医疗保险报销的成本(以瑞士法郎计;1瑞士法郎 = 0.991美元)。

结果

在2013 - 2014年至少有一次住院的202002例患者中,共有270例(0.13%)患者以炎症性肠病作为主要诊断[112例(41.5%)溃疡性结肠炎(UC),158例(58.5%)克罗恩病(CD),154/270例(57.0%)为女性]。与UC患者相比,CD患者使用生物制剂治疗的频率显著更高(45.6%对20.5%,P < 0.001),且在首次住院期间接受手术的频率更高(27.8%对9.8%,P = 0.002)。与UC患者相比,CD患者的会诊次数显著更多[比值比(OR):1.06,95%置信区间(CI):1.01 - 1.12,P = 0.016],年度总费用中位数更高(OR:1.25,95% CI:1.05 - 1.48,P = 0.012),门诊费用更高(OR:1.33,95% CI:1.07 - 1.66,P = 0.011)。在双变量模型中,CD患者和UC患者的总费用中位数分别为24270瑞士法郎和17270瑞士法郎(P = 0.032)。

结论

与UC患者相比,CD住院患者在1年随访期间门诊会诊率更高,产生的费用也更高。

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