长期随访的anca相关性血管炎患者住院费用的驱动因素——现实世界的成本分析

IF 4.6 2区 医学 Q1 UROLOGY & NEPHROLOGY
Clinical Kidney Journal Pub Date : 2025-08-29 eCollection Date: 2025-09-01 DOI:10.1093/ckj/sfaf267
Jolijn R van Leeuwen, Frouzan H Soltani, Wilbert B van den Hout, Ton J Rabelink, Y K Onno Teng
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引用次数: 0

摘要

背景:抗中性粒细胞细胞质抗体(ANCA)相关血管炎(AAV)是一种潜在危及生命的系统性自身免疫性疾病,具有复发风险高和治疗相关毒性,使AAV成为一种高成本疾病。本研究旨在确定临床医生在考虑这一成本负担方面的临床见解。方法:我们进行了详细的、回顾性的、单中心的、基于活动的成本分析,并确定了与成本增加相关的临床变量。我们分析了该医院在2018年1月至2019年12月期间发生的实际成本,忽略了门诊药房的支出。我们的队列包括自诊断以来至少随访6个月的偶发和流行AAV患者,表明生存期超过初始诊断。结果:180例AAV患者中位随访时间为1.8年,平均住院费用为每位患者每年9887欧元,住院治疗是主要的成本驱动因素(32%)。只有15%的费用可归因于患者复发(N = 14/ 180,8 %)。更重要的是,71%的费用可归因于感染患者(N = 77/ 180,43%)。同样,60%的费用可归因于多重合并症患者(N = 65/ 180,36%)。感染和多重合并症都与皮质类固醇(CS)的使用密切相关。回归分析和敏感性分析表明,减少感染、合并症和CS维持治疗将降低医院成本。结论:这一现实世界的成本分析表明,感染和合并症的负担,两者都与使用CS有关,高于AAV患者复发的医院费用。因此,本研究提示考虑医院费用的临床医生应侧重于减少CS和实现无CS缓解,以预防感染和合并症。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Drivers of hospital costs in ANCA-associated vasculitis patients with long-term follow-up-a real-world cost analysis.

Drivers of hospital costs in ANCA-associated vasculitis patients with long-term follow-up-a real-world cost analysis.

Drivers of hospital costs in ANCA-associated vasculitis patients with long-term follow-up-a real-world cost analysis.

Drivers of hospital costs in ANCA-associated vasculitis patients with long-term follow-up-a real-world cost analysis.

Background: Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a potentially life-threatening, systemic autoimmune disease with a high risk for relapse and treatment-related toxicity, making AAV a high-costs illness. This study aimed to identify clinical insights for clinicians on considering this costs burden.

Methods: We conducted a detailed, retrospective, single-centre, activity-based cost-analysis and identified clinical variables associated with increased costs. We analysed real-world costs incurred by the hospital between January 2018 and December 2019, omitting the outpatient pharmacy expenditures. Our cohort included both incident and prevalent AAV patients with at least 6 months of follow-up since diagnosis, indicating survival beyond initial diagnosis.

Results: For 180 AAV patients with a median follow-up of 1.8 years the average hospital costs incurred amounted to €9887 per patient year, with inpatient care being the primary cost driver (32%). Merely 15% of costs were attributable to patients experiencing relapse (N = 14/180, 8%). More importantly, 71% of costs were attributable to patients experiencing infections (N = 77/180, 43%). Likewise, 60% of costs were attributable to patients with multi-comorbidity (N = 65/180, 36%). Infections and multi-comorbidity were both strongly associated with corticosteroid (CS) use. Regression and sensitivity analyses suggest that a reduction of infections, comorbidities and maintenance treatment with CS will reduce hospital costs.

Conclusion: This real-world cost analysis demonstrates that the burden of infections and comorbidities, both related to CS use, is higher than that of relapses on hospital costs in AAV patients. Thus, this study implicates clinicians considering hospital costs should focus on reducing CS and achieving CS-free remission to prevent infections and comorbidities.

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来源期刊
Clinical Kidney Journal
Clinical Kidney Journal Medicine-Transplantation
CiteScore
6.70
自引率
10.90%
发文量
242
审稿时长
8 weeks
期刊介绍: About the Journal Clinical Kidney Journal: Clinical and Translational Nephrology (ckj), an official journal of the ERA-EDTA (European Renal Association-European Dialysis and Transplant Association), is a fully open access, online only journal publishing bimonthly. The journal is an essential educational and training resource integrating clinical, translational and educational research into clinical practice. ckj aims to contribute to a translational research culture among nephrologists and kidney pathologists that helps close the gap between basic researchers and practicing clinicians and promote sorely needed innovation in the Nephrology field. All research articles in this journal have undergone peer review.
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