美国从轻度认知障碍发展到阿尔茨海默病的经济影响

Feride H. Frech, G. Li, T. Juday, Y. Ding, S. Mattke, A. Khachaturian, A. S. Rosenberg, C. Ndiba-Markey, A. Rava, R. Batrla, S. De Santi, H. Hampel
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引用次数: 0

摘要

背景关于从轻度认知功能障碍(MCI)发展为阿尔茨海默病和相关痴呆症(ADRD)的个人经济负担的证据有限.目的评估与稳定型MCI患者相比,确诊MCI后发展为ADRD的个人的全因医疗资源利用率和成本.设计这是一项回顾性队列研究,研究时间为2014年1月1日至2019年12月31日.研究使用Merative MarketScan商业数据库和医疗保险数据库.参与者只要符合以下条件即可纳入研究:(1)年龄在50岁或以上;(2)根据国际疾病分类第九版(ICD-9)代码,有≥1项MCI诊断索赔:(1) 年龄在 50 岁或以上;(2) 根据《国际疾病分类》第九版(ICD-9)代码 331.83 或《国际疾病分类》第十版(ICD-10)代码 G31.84 诊断为 MCI 的索赔次数≥1 次;且连续参保。测量结果包括MCI确诊后头12个月内每位患者每年的全因使用率和费用,包括住院、急诊科就诊、门诊就诊和药房报销等方面的总费用和护理费用。结果在纳入的 5185 人中,1962 人(37.8%)发展为 ADRD(MCI-to-ADRD 亚组),3223 人(62.2%)没有发展为 ADRD(稳定 MCI 亚组)。与稳定型 MCI 亚组相比,MCI-ADRD 亚组所有护理机构的调整后全因使用率更高。调整后的全因平均总费用(34599 美元 vs 24541 美元;平均比率 [MR],1.41 [95% CI,1.31-1.51];P< .001)、住院费用(47463 美元 vs 38004 美元;MR,1.25 [95% CI, 1.08-1.44]; P=.002)、急诊室费用(4875 美元 vs 3863 美元;MR, 1.26 [95% CI, 1.11-1.43]; P<.001)和门诊费用(16652 美元 vs 13015 美元;MR, 1.结论 从 MCI 发展为 ADRD 的个体的医疗费用显著高于稳定 MCI 的个体。早期识别MCI并延缓其进展对改善患者和经济效益非常重要。
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Economic Impact of Progression from Mild Cognitive Impairment to Alzheimer Disease in the United States

Background

Limited evidence exists on the economic burden of individuals who progress from mild cognitive impairment (MCI) to Alzheimer disease and related dementia disorders (ADRD).

Objectives

To assess the all-cause health care resource utilization and costs for individuals who develop ADRD following an MCI diagnosis compared to those with stable MCI.

Design

This was a retrospective cohort study from January 01, 2014, to December 31, 2019.

Setting

The Merative MarketScan Commercial and Medicare Databases were used.

Participants

Individuals were included if they: (1) were aged 50 years or older; (2) had ≥1 claim with an MCI diagnosis based on the International Classification of Diseases, Ninth Revision (ICD-9) code of 331.83 or the Tenth Revision (ICD-10) code of G31.84; and had continuous enrollment. Individuals were excluded if they had a diagnosis of Parkinson’s disease or ADRD or prescription of ADRD medication.

Measurements

Outcomes included all-cause utilization and costs per patient per year in the first 12 months following MCI diagnosis, in total and by care setting: inpatient admissions, emergency department (ED) visits, outpatient visits, and pharmacy claims.

Results

Out of the total of 5185 included individuals, 1962 (37.8%) progressed to ADRD (MCI-to-ADRD subgroup) and 3223 (62.2%) did not (Stable MCI subgroup). Adjusted all-cause utilization was higher for all care settings in the MCI-to-ADRD subgroup compared with the Stable MCI subgroup. Adjusted all-cause mean total costs ($34599 vs $24541; mean ratio [MR], 1.41 [95% CI, 1.31–1.51]; P<.001), inpatient costs ($47463 vs $38004; MR, 1.25 [95% CI, 1.08–1.44]; P=.002), ED costs ($4875 vs $3863; MR, 1.26 [95% CI, 1.11–1.43]; P<.001), and outpatient costs ($16652 vs $13015; MR, 1.28 [95% CI, 1.20–1.37]; P<.001) were all significantly higher for the MCI-to-ADRD subgroup compared with the Stable MCI subgroup.

Conclusions

Individuals who progressed from MCI to ADRD had significantly higher health care costs than individuals with stable MCI. Early identification of MCI and delaying its progression is important to improve patient and economic outcomes.

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The Journal of Prevention of Alzheimer's Disease
The Journal of Prevention of Alzheimer's Disease Medicine-Psychiatry and Mental Health
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期刊介绍: The JPAD Journal of Prevention of Alzheimer’Disease will publish reviews, original research articles and short reports to improve our knowledge in the field of Alzheimer prevention including: neurosciences, biomarkers, imaging, epidemiology, public health, physical cognitive exercise, nutrition, risk and protective factors, drug development, trials design, and heath economic outcomes.JPAD will publish also the meeting abstracts from Clinical Trial on Alzheimer Disease (CTAD) and will be distributed both in paper and online version worldwide.We hope that JPAD with your contribution will play a role in the development of Alzheimer prevention.
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