Natural history, risk prediction and cost of cirrhosis in insured Americans.

受保美国人的肝硬化自然史、风险预测和费用。

• 批准号: 10557845
• 负责人: Daniela P Ladner
• 金额: $ 67.38万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-02-01 至 2026-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10557845
• 关键词: Adult; Affect; Algorithms; Ambulatory Care; American; Ascites; Caring; Cessation of life; Child; Chronic Disease; Cirrhosis; Compensation; Complex; Cost Analysis; Country; Data; Data Set; Diagnosis; Disease Progression; Drops; Early identification; End stage renal failure; Endoscopy; Event; Gastrointestinal Hemorrhage; Guidelines; Health; Health Expenditures; Hepatic Encephalopathy; Hepatorenal Syndrome; Hospital Costs; Hospitalization; Inpatients; Italy; Kidney Diseases; Knowledge; Laboratories; Life Expectancy; Life Experience; Liver; Liver Cirrhosis; Longitudinal cohort; Methods; Modeling; Morbidity - disease rate; Natural History; Patient Care; Patient-Focused Outcomes; Patients; Peritonitis; Persons; Pharmaceutical Preparations; Phenotype; Population; Preparation; Prevalence; Primary carcinoma of the liver cells; Procedures; Recommendation; Recurrence; Reporting; Research; Risk; Sampling; Screening for cancer; Services; Specialist; Standardization; System; Testing; Time; Transplantation; United States; Visit; adjudication; care costs; clinically relevant; cohort; cost; cost effective intervention; cost effectiveness; data repository; demographics; disability; end stage liver disease; follow-up; high risk; hospitalization rates; improved; improved outcome; indexing; longitudinal dataset; mortality; mortality risk; novel; perioperative mortality; population based; predictive modeling; risk prediction; risk prediction model; risk stratification; sound

SUMMARY Cirrhosis is a leading cause of mortality in the United States (US), diagnosed in 1.5-9.4 million Americans and results in over 40,000 deaths each year. Every year 5-7% patients with cirrhosis experience life-threatening decompensating events, such as ascites, hepatic encephalopathy (HE), gastrointestinal bleeding (GIB), or develop hepatocellular carcinoma (HCC). These events often result in hospitalization, disability, or even death. The challenge is to accurately predict those patients who are likely to develop decompensating events and are likely to die. Accurate risk stratification of persons with cirrhosis will allow for early identification and prioritization for guideline recommended care and emerging therapies (e.g., statins). Several predictive models exist but none of them adequately answers this question. Furthermore, no longitudinal cost of care analyses and cost prediction has been performed in the US for persons with cirrhosis. The care of patients with cirrhosis is complex, often involving costly recurrent hospitalizations and procedures. In 2015, the hospital costs alone were reported to be $16.3 billion. Our proposed research will analyze a large national administrative health payer with detailed information on diagnoses, procedures, laboratory tests, medications, in- and outpatient care, as well as standardized costs for insured Americans between 2011 and 2018. Such a large population-based cirrhosis cohort, which includes cost data, offers a unique and unprecedented opportunity to study disease progression, develop highly accurate prediction models, and study costs. Aim 1. To describe the natural history of cirrhosis over time in a large longitudinal cohort of insured Americans with liver cirrhosis in the United States Aim 1.1: Data preparation and variable transformation Aim 1.2: Adjudicate potentially risk-relevant covariates by a cirrhosis stakeholder panel Aim 1.3: Describe the natural history of cirrhosis Aim 2. To predict the risk of decompensation, hospitalization and death in patients with cirrhosis using a large longitudinal administrative dataset (UNITED Health Group) Aim 2.1: Model the risk of decompensation Aim 2.2: Model the risk of hospitalization Aim 2.3: Merge the UHG dataset with the National Death Index and model the risk of death Aim 3: To predict costs associated with all aspects of care in patients with liver cirrhosis Aim 3.1: Ascertain standardized cost stratified by state/phenotypes of liver cirrhosis Aim 3.2: Model the cost of care over time

概括 肝硬化是美国死亡率的主要原因（美国），在15-940万美国人中被诊断出 每年导致40,000多人死亡。每年有5-7％的肝硬化患者会危及生命 代偿事件，例如腹水，肝脑病（HE），胃肠道出血（GIB）或 发展肝细胞癌（HCC）。这些事件通常会导致住院，残疾甚至死亡。 面临的挑战是准确预测那些可能发展代偿事件的患者 并可能死亡。肝硬化患者的准确风险分层将允许早期识别 指南建议的护理和新兴疗法（例如他汀类药物）的优先级。一些 存在预测模型，但没有一个充分回答这个问题。此外，没有纵向费用 在美国为肝硬化患者进行了护理分析和成本预测。护理 肝硬化的患者很复杂，通常涉及昂贵的住院和程序。 2015年 据报道，仅医院费用为163亿美元。我们拟议的研究将分析一个大型国家 行政卫生付款人提供有关诊断，程序，实验室测试，药物的详细信息， 2011年至2018年之间，美国人的门诊和门诊护理以及被保险人的标准化成本。 包括成本数据在内的大型基于人群的肝硬化队列提供了独特且前所未有的机会 研究疾病进展，开发高度准确的预测模型和研究成本。 目的1。在大量的被保险人群中描述肝硬化的自然历史 美国患有肝肝硬化的美国人 AIM 1.1：数据准备和可变转换 AIM 1.2：通过肝硬化利益相关者面板裁定潜在的风险与风险的协变量 目标1.3：描述肝硬化的自然史 目的2。预测使用肝硬化患者的失代偿，住院和死亡的风险 一个大型纵向行政数据集（联合卫生小组） AIM 2.1：建模失代偿风险 目标2.2：建模住院风险 目标2.3：将UHG数据集与国家死亡指数合并并建模死亡风险 目标3：预测肝硬化患者的护理各个方面相关的成本 AIM 3.1：确定标准化成本由肝脏肝硬化的状态/表型分层 AIM 3.2：随着时间的推移对护理成本进行建模