意大利系统性红斑狼疮成年患者的临床特征及直接医疗护理成本

Clinical profile and direct medical cost of care of adults presenting with systemic lupus erythematosus in Italy.

作者信息

Doria Andrea, Iaccarino Luca, La Montagna Giovanni, Mathieu Alessandro, Piga Matteo, Galeazzi Mauro, Iuliano Annamaria, Maurel Frédérique B, Garofano Anna M, Perna Alessandra G, Porcasi Rolando E

机构信息

Rheumatology Unit, Department of Medicine, University of Padova, Padova, Italy.

Rheumatology Unit, Second University of Napoli, Napoli, Italy.

出版信息

Clin Exp Rheumatol. 2015 May-Jun;33(3):375-84. Epub 2015 May 25.

PMID:26005879

Abstract

OBJECTIVES

To determine the clinical profile and estimate the annual direct medical cost of care of adult patients with active, autoantibody positive systemic lupus erythematosus (SLE) in Italy.

METHODS

A two-year, retrospective, multicentre, observational study was conducted from January to May 2011. Patients' characteristics, SLE disease activity and severity, rate of flares, healthcare consumption (e.g. medications, etc.) were evaluated. Medical costs were assessed from the Italian National Health Insurance perspective.

RESULTS

Four centres enrolled 96 eligible patients, including 85.4% women. Patients were equally stratified per disease severity (severe SLE: 51%). The mean (SD) age was 42.9 (13.8) years. At baseline, SLE duration was 12.6 (7.2) years. The mean (SD) SELENA-SLEDAI score was higher in severe than in non-severe patients 9.2 (6.4) vs. 3.3 (3.1) (p<0.001). The mean (SD) SLICC/ACR index score was similar in the two subgroups: 0.4 (0.8) vs. 0.3 (0.8). Over the study period, severe patients experienced on average 0.73 (0.56) flares/year and non-severe patients 0.57 (0.63). The annual medical cost was 1.6 times higher in severe than in non-severe patients (€2,101 vs. €1,320; p=0.031). The cost of medications was also 2.5 times higher in severe patients (€1101 vs. €445, p=0.007). Low C3/C4 complement levels and each severe flare incremented the annual cost of €550 (p=0.011) and €465 (p=0.02), respectively.

CONCLUSIONS

The medical cost of SLE in Italy is related to disease severity and flares. Medications identified as the main cost drivers, and low C3/C4 complement levels and severe flares as the main cost predictors, increased significantly the cost of SLE management.

摘要

目的

确定意大利成年活动性、自身抗体阳性系统性红斑狼疮（SLE）患者的临床特征，并估算其每年的直接医疗护理成本。

方法

于2011年1月至5月进行了一项为期两年的回顾性、多中心观察性研究。评估了患者的特征、SLE疾病活动度和严重程度、病情复发率、医疗保健消耗（如药物等）。从意大利国家医疗保险的角度评估医疗成本。

结果

四个中心纳入了96例符合条件的患者，其中女性占85.4%。患者按疾病严重程度进行了均衡分层（重度SLE：51%）。平均（标准差）年龄为42.9（13.8）岁。基线时，SLE病程为12.6（7.2）年。重度患者的平均（标准差）SELENA - SLEDAI评分高于非重度患者，分别为9.2（6.4）和3.3（3.1）（p<0.001）。两个亚组的平均（标准差）SLICC/ACR指数评分相似：0.4（0.8）和0.3（0.8）。在研究期间，重度患者平均每年经历0.73（0.56）次病情复发，非重度患者为0.57（0.63）次。重度患者的年度医疗成本比非重度患者高1.6倍（2101欧元对1320欧元；p = 0.031）。重度患者的药物成本也比非重度患者高2.5倍（1101欧元对445欧元，p = 0.007）。低C3/C4补体水平和每次重度病情复发分别使年度成本增加550欧元（p = 0.011）和465欧元（p = 0.02）。