Division of Rheumatology, University of Padova, , Padova, Italy.
Ann Rheum Dis. 2014 Jan;73(1):154-60. doi: 10.1136/annrheumdis-2012-202443. Epub 2012 Dec 21.
To evaluate the annual direct medical cost of managing adult systemic lupus erythematosus (SLE) patients with active autoantibody positive disease in Europe.
A 2-year, retrospective, multicentre, observational study was conducted in five countries (France, Germany, Italy, Spain and the UK). Data included patients' characteristics, disease activity and severity, flare assessments and health resource use (eg, laboratory tests, medications, specialist visits and hospitalisations). Costs were assessed from the public payers' perspective. Cost predictors were estimated by multivariate regression models.
Thirty-one centres enrolled 427 consecutive eligible patients stratified equally by disease severity. At baseline, mean (SD) age was 44.5 (13.8) years, 90.5% were women and mean (SD) SLE duration was 10.7 (8.0) years. The SELENA-SLEDAI (11.2 vs 5.3) and SLICC/ACR index (1.0 vs 0.7) scores were higher in severe patients. Over the study period, patients experienced on average 1.02 (0.71) flares/year. The mean annual direct medical cost was higher in severe compared to non-severe patients (€4748 vs €2650, p<0.001). Medication costs were €2518 in severe versus €1251 in non-severe patients (p<0.001). Medications represented 53% and 47% of the total cost for severe and non-severe patients, respectively, primarily due to immunosuppressants and biologics. Flares, especially severe flares, were identified as the major cost predictor, with each flare increasing the annual total cost by about €1002 (p<0.001).
The annual direct medical cost of SLE patients in Europe is related to disease severity and flares. Medical treatments were the main cost drivers. Severe flares and major organ involvement were identified as important cost predictors.
评估欧洲活动性自身抗体阳性的成人系统性红斑狼疮（SLE）患者的年直接医疗成本。
在五个国家（法国、德国、意大利、西班牙和英国）进行了一项为期两年的回顾性、多中心、观察性研究。数据包括患者的特征、疾病活动度和严重程度、病情加重评估以及卫生资源利用（例如实验室检查、药物、专科就诊和住院治疗）。成本从公共支付者的角度进行评估。通过多元回归模型估计成本预测因素。
31 个中心纳入了 427 名符合条件的连续患者，按疾病严重程度平均分为两组。基线时，患者的平均（标准差）年龄为 44.5（13.8）岁，90.5%为女性，SLE 病程的平均（标准差）为 10.7（8.0）年。SELENA-SLEDAI（11.2 分比 5.3 分）和 SLICC/ACR 指数（1.0 分比 0.7 分）评分在严重患者中更高。在研究期间，患者平均每年经历 1.02（0.71）次病情加重。与非严重患者相比，严重患者的年直接医疗费用更高（€4748 比 €2650，p<0.001）。严重患者的药物费用为€2518，而非严重患者为€1251（p<0.001）。药物分别占严重和非严重患者总费用的 53%和 47%，主要是由于免疫抑制剂和生物制剂。病情加重，特别是严重病情加重，被确定为主要的成本预测因素，每次病情加重都会使年总费用增加约€1002（p<0.001）。
欧洲 SLE 患者的年直接医疗成本与疾病严重程度和病情加重有关。医疗治疗是主要的成本驱动因素。严重病情加重和主要器官受累被确定为重要的成本预测因素。
