[法国成年活动性及已接受治疗的系统性红斑狼疮患者的疾病成本（LUCIE研究）]

[Cost of systemic lupus erythematosus for adult patients with active and treated disease in France (LUCIE study)].

作者信息

Amoura Z, Deligny C, Pennaforte J-L, Hamidou M, Blanco P, Hachulla E, Pourrat J, Queyrel V, Garofano A, Maurel F, Levy-Bachelot L, Boucot I

机构信息

Service de médecine interne 2, Centre national de référence lupus, hôpital La Pitié-Salpétrière, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.

Service de médecine interne et rhumatologie, CHU de Fort-de-France, BP 63297261, Fort-de-France cedex, Martinique.

出版信息

Rev Med Interne. 2014 Nov;35(11):700-8. doi: 10.1016/j.revmed.2014.02.001. Epub 2014 Mar 12.

DOI:10.1016/j.revmed.2014.02.001

PMID:24630588

Abstract

PURPOSE

To evaluate in France the annual direct medical cost of adult patients with active systemic lupus erythematosus (SLE) on medication and estimate the cost of a flare.

METHODS

A two-year, observational, retrospective, multicenter study, carried out between December 2010 and February 2011. Patients' characteristics, SLE disease activity and severity, rate of flares, healthcare consumption (medications, hospitalisations, etc.) were evaluated. Medical costs were assessed from the national Health Insurance perspective. Cost predictors were estimated using multivariate regression models.

RESULTS

Eight centres specialized in SLE management included 93 eligible patients (including 50.5% severe). The mean age was 39.9 (11.9) years and 93.5% were women. At baseline, the mean SLE duration was 9.8 (6.6) years. The mean scores of the SELENA-SLEDAI instrument and the SLICC/ACR index were higher in severe patients (9.8 vs 5.6, and 1.2 vs 0.4 respectively; P<0.001). Over the study period, 51% of patients received the combination containing at least corticosteroids or immunosuppressants. The mean annual direct medical cost of severe patients was €4660 versus €3560 for non-severe patients (non-significant difference). The cost of medications (61.8% of the annual cost) was higher in severe patients (€3214 vs €1856; P<0.05). Immunosuppressants and biologics represented 26.5% and 4.6% of the annual total cost respectively. Patients experienced on average 1.10 (0.59) flares/year, of which 0.50 were severe flare. The occurrence of a new severe flare incremented the annual cost of €1330 (P<0.05).

CONCLUSION

Medications represented the major component of the annual direct medical cost. Severe flares increase significantly the cost of SLE care management.

摘要

目的

在法国评估正在接受药物治疗的成年活动性系统性红斑狼疮（SLE）患者的年度直接医疗费用，并估算病情复发的成本。

方法

一项为期两年的观察性、回顾性、多中心研究，于2010年12月至2011年2月开展。对患者的特征、SLE疾病活动度和严重程度、病情复发率、医疗保健消耗（药物、住院等）进行了评估。从国家医疗保险的角度评估医疗费用。使用多元回归模型估计成本预测因素。

结果

8个SLE管理专科中心纳入了93例符合条件的患者（其中50.5%为重症患者）。平均年龄为39.9（11.9）岁，93.5%为女性。基线时，SLE平均病程为9.8（6.6）年。重症患者的SELENA-SLEDAI工具和SLICC/ACR指数的平均得分更高（分别为9.8对5.6以及1.2对0.4；P<0.001）。在研究期间，51%的患者接受了至少含有皮质类固醇或免疫抑制剂的联合治疗。重症患者的年度直接医疗费用平均为4660欧元，非重症患者为3560欧元（差异无统计学意义）。重症患者的药物费用（占年度费用的61.8%）更高（3214欧元对1856欧元；P<0.05）。免疫抑制剂和生物制剂分别占年度总费用的26.5%和4.6%。患者平均每年经历1.10（0.59）次病情复发，其中0.50次为严重复发。新发生一次严重复发会使年度费用增加1330欧元（P<0.05）。