英国新诊断的系统性红斑狼疮成人的医疗资源使用和与器官损伤相关的费用,Rheumatology and Therapy

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英国新诊断的系统性红斑狼疮成人的医疗资源使用和与器官损伤相关的费用
Rheumatology and Therapy ( IF 2.9 ) Pub Date : 2023-07-03 , DOI: 10.1007/s40744-023-00567-9
Heide A Stirnadel-Farrant _{1,

2} , Sarowar M Golam ₃ , Barbara Naisbett-Groet ₁ , Danny Gibson ₄ , Julia Langham ₅ , Sue Langham ₆ , Mihail Samnaliev ₇

Affiliation

介绍

该分析比较了系统性红斑狼疮 (SLE) 成年患者队列中的医疗资源使用 (HCRU) 和与事件器官损伤相关的成本。

方法

确定了 SLE 病例（临床实践研究数据链 [CPRD] 和医院发病统计数据链接的医疗保健数据库；2005 年 1 月 1 日至 2019 年 6 月 30 日）。从 SLE 诊断到随访，计算了 13 个器官损伤领域的年发生率。使用广义估计方程比较器官损伤和非器官损伤患者组的年化 HCRU 和费用。

结果

共有 936 名患者符合 SLE 纳入标准。平均年龄为 48.0（标准差 [SD] 15.7）岁，88% 为女性。在中位随访 4.3 年（四分位距 [IQR] 1.9-7.0）年中，59% (315/533) 有证据表明 SLE 诊断后发生器官损伤（≥ 1 种类型），其中肌肉骨骼损伤最为严重（ 146/819 [18%]）、心血管（149/842 [18%]）和皮肤（148/856 [17%]）领域。与没有器官损伤的患者相比，有器官损伤的患者对所有器官系统（不包括性腺）的资源使用量更大。总体而言，有器官损伤的患者的年均全因 HCRU 平均值 (SD) 高于无器官损伤的患者（住院患者，1.0 天与 0.2 天；门诊患者，7.3 天与 3.5 天；事故和紧急情况，0.5 天与 0.2 天；初级保健接触者，28.7 天与16.5；处方药，62.3 与 22.9）。与无器官损伤的患者相比，在器官损伤指数期后和前的调整后平均年化全因成本均显着更高（所有P < 0.05，不包括性腺）。总体器官损伤与调整后平均每位患者年化费用显着增加相关（增加 4442 英镑 [ P < 0.0001]），根据器官损伤类型，费用范围在 2709 英镑至 7150 英镑之间。

结论

在 SLE 诊断前后，器官损伤与较高的 HCRU 和医疗费用相关。更有效的 SLE 管理可以减缓疾病进展、预防器官损伤、改善临床结果并降低医疗成本。

"点击查看英文标题和摘要"

Healthcare Resource Use and Costs Associated with Organ Damage in Newly Diagnosed Adults with Systemic Lupus Erythematosus in the UK

Introduction

This analysis compared healthcare resource use (HCRU) and costs associated with incident organ damage in a cohort of adult patients with systemic lupus erythematosus (SLE).

Methods

Incident SLE cases were identified (Clinical Practice Research Datalink [CPRD] and Hospital Episode Statistics-linked healthcare databases; January 1, 2005–June 30, 2019). Annual incidence of 13 organ damage domains was calculated from SLE diagnosis through follow-up. Annualized HCRU and costs were compared between organ damage and non-organ damage patient groups using generalized estimating equations.

Results

A total of 936 patients met the inclusion criteria for SLE. Mean age was 48.0 (standard deviation [SD] 15.7) years and 88% were female. Over a median follow-up period of 4.3 (interquartile range [IQR] 1.9–7.0) years, 59% (315/533) had evidence of post-SLE diagnosis incident organ damage (≥ 1 type), which was greatest for musculoskeletal (146/819 [18%]), cardiovascular (149/842 [18%]), and skin (148/856 [17%]) domains. Patients with organ damage had greater resource use for all organ systems, excluding gonadal, versus those without it. Overall, mean (SD) annualized all-cause HCRU was greater in patients with organ damage versus those without it (inpatient, 1.0 versus 0.2; outpatient, 7.3 versus 3.5; accident and emergency, 0.5 versus 0.2 days; primary care contacts, 28.7 versus 16.5; prescription medications, 62.3 versus 22.9). Adjusted mean annualized all-cause costs were significantly greater in both post- and pre-organ damage index periods for patients with organ damage versus those without it (all P < 0.05, excluding gonadal). Overall organ damage was associated with significantly increased adjusted mean annualized per-patient cost (£4442 greater [P < 0.0001]) ranging between £2709 and £7150 greater depending on the organ damage type.

Conclusion

Organ damage was associated with higher HCRU and healthcare costs, before and after SLE diagnosis. More effective SLE management may slow disease progression, prevent organ damage onset, improve clinical outcomes, and reduce healthcare costs.

更新日期：2023-07-05

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