Morrisroe Kathleen, Stevens Wendy, Sahhar Joanne, Ngian Gene-Siew, Rabusa Candice, Ferdowsi Nava, Hill Catherine, Proudman Susanna, Nikpour Mandana
Department of Medicine, The University of Melbourne at St Vincent's Hospital (Melbourne) Department of Rheumatology, St Vincent's Hospital (Melbourne) Department of Medicine, Monash University, Clayton and Monash Health, Victoria Rheumatology Unit, Royal Adelaide Hospital, North Terrace Rheumatology Unit, The Queen Elizabeth Hospital, Woodville Road, Woodville Discipline of Medicine, University of Adelaide, SA, Australia.
Medicine (Baltimore). 2017 Dec;96(48):e8503. doi: 10.1097/MD.0000000000008503.
To quantify the direct healthcare cost of systemic sclerosis (SSc) and identify its determinants. Healthcare use was captured through data linkage, wherein clinical and medication data for SSc patients from the state of Victoria enrolled in the Australian Scleroderma Cohort Study were linked with the Victorian hospital admissions and emergency presentations data sets, and the Medicare Benefits Schedule which contains all government subsidized ambulatory care services, for the period 2011-2015. Medication cost was determined from the Pharmaceutical Benefits Scheme. Costs were extrapolated to all Australian SSc patients based on SSc prevalence of 21.1 per 100,000 and an Australian population of 24,304,682 in 2015. Determinants of healthcare cost were estimated using logistic regression. Total healthcare utilization cost to the Australian government extrapolated to all Australian SSc patients from 2011 to 2015 was Australian Dollar (AUD)$297,663,404.77, which is an average annual cost of AUD$59,532,680.95 (US Dollar [USD]$43,816,040.08) and annual cost per patient of AUD$11,607.07 (USD$8,542.80). Hospital costs, including inpatient hospitalization and emergency department presentations, accounted for the majority of these costs (44.4% of total), followed by medication cost (31.2%) and ambulatory care cost (24.4%). Pulmonary arterial hypertension (PAH) and gastrointestinal (GIT) involvement were the major determinants of healthcare cost (OR 2.3 and 1.8, P = .01 for hospitalizations; OR 2.8 and 2.0, P = .01 for ambulatory care; OR 7.8 and 1.6, P < .001 and P = .03 for medication cost, respectively). SSc is associated with substantial healthcare utilization and direct economic burden. The most costly aspects of SSc are PAH and GIT involvement.
量化系统性硬化症（SSc）的直接医疗成本并确定其决定因素。通过数据链接获取医疗保健使用情况，即将参加澳大利亚硬皮病队列研究的维多利亚州SSc患者的临床和用药数据与维多利亚州医院入院和急诊就诊数据集以及包含2011 - 2015年期间所有政府补贴门诊护理服务的医疗保险福利计划相链接。药物成本由药品福利计划确定。根据2015年每10万人中21.1例的SSc患病率以及澳大利亚24,304,682的人口数量，将成本推算至所有澳大利亚SSc患者。使用逻辑回归估计医疗成本的决定因素。2011年至2015年推算至所有澳大利亚SSc患者的澳大利亚政府总医疗保健利用成本为297,663,404.77澳元，即平均每年成本为59,532,680.95澳元（43,816,040.08美元），每位患者每年成本为11,607.07澳元（8,542.80美元）。医院成本，包括住院治疗和急诊科就诊，占这些成本的大部分（占总数的44.4%），其次是药物成本（31.2%）和门诊护理成本（24.4%）。肺动脉高压（PAH）和胃肠道（GIT）受累是医疗成本的主要决定因素（住院治疗的OR分别为2.3和1.8，P = 0.01；门诊护理的OR分别为2.8和2.0，P = 0.01；药物成本的OR分别为7.8和1.6，P < 0.001和P = 0.03）。SSc与大量的医疗保健利用和直接经济负担相关。SSc最昂贵的方面是PAH和GIT受累。
