Barry Hendin, Richard Brook, Ian Beren, Nathan Kleinman, Cindy Fink, Amy Phillips, Carroline Lobo
{"title":"不同疾病严重程度的多发性硬化症患者护理伙伴员工的临床和经济影响","authors":"Barry Hendin, Richard Brook, Ian Beren, Nathan Kleinman, Cindy Fink, Amy Phillips, Carroline Lobo","doi":"10.36469/jheor.2023.57593","DOIUrl":null,"url":null,"abstract":"Background: Research on employee care partners of patients with multiple sclerosis (MS) is limited. Objectives: The clinical and economic impact on employee care partners was evaluated by MS disease severity. Methods: Employees with spouses/domestic partners with MS from the Workpartners database (Jan. 1, 2010–Dec. 31, 2019) were eligible if: spouse/partner had at least 3 MS-related (ICD-9-CM/ICD-10-CM:340.xx/G35) inpatient/outpatient/disease-modifying therapy claims within 1 year (latest claim = index date); 6-month pre-index/1-year post-index enrollment; and age 18 to 64 years. Employee care partners’ demographic/clinical characteristics and direct/indirect costs were compared across predetermined MS severity categories. Logistic and generalized linear regression modeled the costs. Results: Among 1041 employee care partners of patients with MS, 358 (34.4%) patients had mild MS, 491 (47.2%) moderate, and 192 (18.4%) severe. Mean (standard error [SE]) employee care partner age was 49.0 (0.5) for patients with mild disease, 50.5 (0.4) for moderate, 51.7 (0.6) for severe; percent female care partners was 24.6% [2.3%] mild, 19.8% [1.8%] moderate, 27.6% [3.2%] severe; and mean care partner Charlson Comorbidity Index scores 0.28 (0.05) mild, 0.30 (0.04) moderate, 0.27 (0.06) severe. More care partners of patients with moderate/severe vs mild MS had hyperlipidemia (32.6%/31.8% vs 21.2%), hypertension (29.5%/29.7% vs 19.3%), gastrointestinal disease (20.8%/22.9% vs 13.1%), depression (9.2%/10.9% vs 3.9%), and anxiety 10.6%/8.9% vs 4.2%). Adjusted mean medical costs were greater for employee care partners of patients with moderate vs mild/severe disease (P<.001). Pharmacy costs (SE) were lower for employee care partners of mild vs severe/moderate patients (P<.005). Sick leave costs (SE) were greater for employee care partners of mild/severe vs moderate patients (P<.05). Discussion: Employee care partners of patients with moderate/severe vs mild MS had more comorbidities (ie, hypertension, gastrointestinal disease, depression, and anxiety) and higher pharmacy costs. Employee care partners of patients with moderate vs mild/severe MS had higher medical and lower sick leave costs. Treatment strategies that improve patient outcomes may reduce employee care partner burden and lower costs for employers in some instances. Conclusions: Comorbidities and direct/indirect costs of employees whose spouses/partners have MS were considerable and varied with MS severity.","PeriodicalId":16012,"journal":{"name":"Journal of Health Economics and Outcomes Research","volume":"1 1","pages":"0"},"PeriodicalIF":2.3000,"publicationDate":"2023-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The Clinical and Economic Impact of Employees Who Are Care Partners of Patients with Multiple Sclerosis by Disease Severity\",\"authors\":\"Barry Hendin, Richard Brook, Ian Beren, Nathan Kleinman, Cindy Fink, Amy Phillips, Carroline Lobo\",\"doi\":\"10.36469/jheor.2023.57593\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Background: Research on employee care partners of patients with multiple sclerosis (MS) is limited. Objectives: The clinical and economic impact on employee care partners was evaluated by MS disease severity. Methods: Employees with spouses/domestic partners with MS from the Workpartners database (Jan. 1, 2010–Dec. 31, 2019) were eligible if: spouse/partner had at least 3 MS-related (ICD-9-CM/ICD-10-CM:340.xx/G35) inpatient/outpatient/disease-modifying therapy claims within 1 year (latest claim = index date); 6-month pre-index/1-year post-index enrollment; and age 18 to 64 years. Employee care partners’ demographic/clinical characteristics and direct/indirect costs were compared across predetermined MS severity categories. Logistic and generalized linear regression modeled the costs. Results: Among 1041 employee care partners of patients with MS, 358 (34.4%) patients had mild MS, 491 (47.2%) moderate, and 192 (18.4%) severe. Mean (standard error [SE]) employee care partner age was 49.0 (0.5) for patients with mild disease, 50.5 (0.4) for moderate, 51.7 (0.6) for severe; percent female care partners was 24.6% [2.3%] mild, 19.8% [1.8%] moderate, 27.6% [3.2%] severe; and mean care partner Charlson Comorbidity Index scores 0.28 (0.05) mild, 0.30 (0.04) moderate, 0.27 (0.06) severe. More care partners of patients with moderate/severe vs mild MS had hyperlipidemia (32.6%/31.8% vs 21.2%), hypertension (29.5%/29.7% vs 19.3%), gastrointestinal disease (20.8%/22.9% vs 13.1%), depression (9.2%/10.9% vs 3.9%), and anxiety 10.6%/8.9% vs 4.2%). Adjusted mean medical costs were greater for employee care partners of patients with moderate vs mild/severe disease (P<.001). Pharmacy costs (SE) were lower for employee care partners of mild vs severe/moderate patients (P<.005). Sick leave costs (SE) were greater for employee care partners of mild/severe vs moderate patients (P<.05). Discussion: Employee care partners of patients with moderate/severe vs mild MS had more comorbidities (ie, hypertension, gastrointestinal disease, depression, and anxiety) and higher pharmacy costs. Employee care partners of patients with moderate vs mild/severe MS had higher medical and lower sick leave costs. Treatment strategies that improve patient outcomes may reduce employee care partner burden and lower costs for employers in some instances. Conclusions: Comorbidities and direct/indirect costs of employees whose spouses/partners have MS were considerable and varied with MS severity.\",\"PeriodicalId\":16012,\"journal\":{\"name\":\"Journal of Health Economics and Outcomes Research\",\"volume\":\"1 1\",\"pages\":\"0\"},\"PeriodicalIF\":2.3000,\"publicationDate\":\"2023-04-13\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Health Economics and Outcomes Research\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.36469/jheor.2023.57593\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ECONOMICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Health Economics and Outcomes Research","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.36469/jheor.2023.57593","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ECONOMICS","Score":null,"Total":0}
引用次数: 0
摘要
背景:对多发性硬化症(MS)患者员工关怀伴侣的研究有限。目的:通过MS疾病严重程度评估对员工护理伙伴的临床和经济影响。方法:工作伙伴数据库中配偶/同居伴侣患有多发性硬化症的员工(2010年1月1日- 2010年12月1日)。如果:配偶/伴侣在1年内至少有3次ms相关(ICD-9-CM/ICD-10-CM:340.xx/G35)住院/门诊/疾病改善治疗索赔(最晚索赔=索引日期);指数前6个月/指数后1年入学;年龄从18岁到64岁。员工护理伙伴的人口统计学/临床特征和直接/间接成本在预定的MS严重程度类别中进行比较。Logistic和广义线性回归对成本进行建模。结果:1041名MS员工护理伴中,轻度MS 358名(34.4%),中度MS 491名(47.2%),重度MS 192名(18.4%)。轻症患者的平均(标准误差[SE])员工护理伴侣年龄为49.0(0.5),中度患者为50.5(0.4),重度患者为51.7 (0.6);女性护理伴为轻度24.6%[2.3%],中度19.8%[1.8%],重度27.6% [3.2%];平均护理伴Charlson共病指数为轻度0.28(0.05),中度0.30(0.04),重度0.27(0.06)。中度/重度MS患者与轻度MS患者的护理伴有高脂血症(32.6%/31.8% vs 21.2%)、高血压(29.5%/29.7% vs 19.3%)、胃肠道疾病(20.8%/22.9% vs 13.1%)、抑郁症(9.2%/10.9% vs 3.9%)、焦虑症(10.6%/8.9% vs 4.2%)。调整后的平均医疗费用对于中度疾病患者的员工护理伙伴大于轻度/重度疾病患者(P<.001)。轻、重度/中度患者的员工护理伙伴的药房费用(SE)低于重、中度患者(P<.005)。轻/重度患者的员工护理伙伴的病假费用(SE)高于中度患者(P< 0.05)。讨论:中度/重度MS患者与轻度MS患者的员工护理伙伴有更多的合并症(即高血压、胃肠道疾病、抑郁和焦虑)和更高的药房费用。中度与轻度/重度多发性硬化症患者的员工护理伙伴有较高的医疗费用和较低的病假费用。在某些情况下,改善患者预后的治疗策略可能会减轻员工护理伙伴的负担,并降低雇主的成本。结论:配偶/伴侣患有多发性硬化症的员工的合并症和直接/间接费用相当可观,且随多发性硬化症严重程度的不同而不同。
The Clinical and Economic Impact of Employees Who Are Care Partners of Patients with Multiple Sclerosis by Disease Severity
Background: Research on employee care partners of patients with multiple sclerosis (MS) is limited. Objectives: The clinical and economic impact on employee care partners was evaluated by MS disease severity. Methods: Employees with spouses/domestic partners with MS from the Workpartners database (Jan. 1, 2010–Dec. 31, 2019) were eligible if: spouse/partner had at least 3 MS-related (ICD-9-CM/ICD-10-CM:340.xx/G35) inpatient/outpatient/disease-modifying therapy claims within 1 year (latest claim = index date); 6-month pre-index/1-year post-index enrollment; and age 18 to 64 years. Employee care partners’ demographic/clinical characteristics and direct/indirect costs were compared across predetermined MS severity categories. Logistic and generalized linear regression modeled the costs. Results: Among 1041 employee care partners of patients with MS, 358 (34.4%) patients had mild MS, 491 (47.2%) moderate, and 192 (18.4%) severe. Mean (standard error [SE]) employee care partner age was 49.0 (0.5) for patients with mild disease, 50.5 (0.4) for moderate, 51.7 (0.6) for severe; percent female care partners was 24.6% [2.3%] mild, 19.8% [1.8%] moderate, 27.6% [3.2%] severe; and mean care partner Charlson Comorbidity Index scores 0.28 (0.05) mild, 0.30 (0.04) moderate, 0.27 (0.06) severe. More care partners of patients with moderate/severe vs mild MS had hyperlipidemia (32.6%/31.8% vs 21.2%), hypertension (29.5%/29.7% vs 19.3%), gastrointestinal disease (20.8%/22.9% vs 13.1%), depression (9.2%/10.9% vs 3.9%), and anxiety 10.6%/8.9% vs 4.2%). Adjusted mean medical costs were greater for employee care partners of patients with moderate vs mild/severe disease (P<.001). Pharmacy costs (SE) were lower for employee care partners of mild vs severe/moderate patients (P<.005). Sick leave costs (SE) were greater for employee care partners of mild/severe vs moderate patients (P<.05). Discussion: Employee care partners of patients with moderate/severe vs mild MS had more comorbidities (ie, hypertension, gastrointestinal disease, depression, and anxiety) and higher pharmacy costs. Employee care partners of patients with moderate vs mild/severe MS had higher medical and lower sick leave costs. Treatment strategies that improve patient outcomes may reduce employee care partner burden and lower costs for employers in some instances. Conclusions: Comorbidities and direct/indirect costs of employees whose spouses/partners have MS were considerable and varied with MS severity.