RESUMEN
BACKGROUND AND AIM: In this study, we used a national cohort of patients with Wilson's disease (WD) to investigate the admissions, mortality rates, and costs over the captured period to assess specific subpopulations at higher burden. METHODS: Patients with WD were selected using 2016-2019 National Inpatient Sample (NIS). The weighted estimates and patient data were stratified using demographics and medical characteristics. Regression curves were graphed to derive goodness-of-fit for each trend from which R2 and P values were calculated. RESULTS: Annual total admissions per 100â 000 hospitalizations due to WD were 1075, 1180, 1140, and 1330 ( R2 â =â 0.75; P â =â 0.13) from 2016 to 2019. Within the demographics, there was an increase in admissions among patients greater than 65 years of age ( R2 â =â 0.90; P â =â 0.05) and White patients ( R2 â =â 0.97; P â =â 0.02). Assessing WD-related mortality rates, there was an increase in the mortality rate among those in the first quartile of income ( R2 â =â 1.00; P â <â 0.001). The total cost for WD-related hospitalizations was $20.90, $27.23, $24.20, and $27.25 million US dollars for the years 2016, 2017, 2018, and 2019, respectively ( R2 â =â 0.47; P â =â 0.32). There was an increasing total cost trend for Asian or Pacific Islander patients ( R2 â =â 0.90; P â =â 0.05). Interestingly, patients with cirrhosis demonstrated a decreased trend in the total costs ( R2 â =â 0.97; P â =â 0.02). CONCLUSION: Our study demonstrated that certain ethnicity groups, income classes and comorbidities had increased admissions or costs among patients admitted with WD.
Asunto(s)
Degeneración Hepatolenticular , Costos de Hospital , Hospitalización , Humanos , Degeneración Hepatolenticular/economía , Degeneración Hepatolenticular/terapia , Degeneración Hepatolenticular/mortalidad , Femenino , Masculino , Estados Unidos/epidemiología , Persona de Mediana Edad , Hospitalización/economía , Hospitalización/estadística & datos numéricos , Adulto , Anciano , Costos de Hospital/estadística & datos numéricos , Adulto Joven , Adolescente , Costos de la Atención en Salud/estadística & datos numéricos , RentaRESUMEN
The economic and health care use burdens of Wilson's disease (WD) are unknown. In this study, we aimed to quantify this health care resource use and economic burden. We performed a retrospective case-control analysis of individuals in the Truven Health MarketScan Commercial Claims database (2007-2017). Using propensity scores, 424 WD cases were matched 1:1 to chronic liver disease (CLD) controls without WD. Total and service-specific parameters, expressed in monthly averages, were quantified for the 6-month pre-WD diagnosis versus the 12-month period after diagnosis. Wilcoxon signed-rank tests and McNemar tests were used to examine incremental differences in burden between cases and controls. Adjusted multivariable generalized linear regression models were used to compare health care burdens. Relative to the 6-month pre-WD diagnosis, the 12 months after diagnosis had more claims per patient (2.87 vs. 3.35; P < 0.0001) and increased per patient health care costs (US $2,089 vs. US $3,887; P < 0.0001). WD cases incurred US $1,908 more in total unadjusted costs compared to controls in the 12-month postindex date monthly averages. The increase in claims was primarily due to outpatient visits (1.62 vs. 1.82) and pharmaceutical claims (1.11 vs. 1.37). Cases also had higher health care costs for inpatient admissions (US $559 vs. US $1,264), outpatient visits (US $770 vs. US $1,037), and pharmaceutical claims (US $686 vs. US $1,489). Conclusion: WD is associated with significant health care cost and use burdens driven by increased inpatient admissions, outpatient visits, and pharmaceutical claims.