Rheumatology department, université Paris Est Créteil, Henri-Mondor Hospital, EA 7379, EpidermE, AP-HP, 94010 Créteil, France.
Cemka-Eval, 92340 Bourg-la-Reine, France.
Joint Bone Spine. 2019 Jan;86(1):69-75. doi: 10.1016/j.jbspin.2018.04.003. Epub 2018 Apr 27.
To estimate the number of patients with severe spondyloarthritis (SpA) in France, describe their comorbidities and document and value their healthcare resource consumption.
Data were retrieved from an insurance claims database covering a 1/97 random sample of the French population. All patients benefiting from full insurance coverage ("ALD") for severe SpA in 2012 (including cases with structural damage and/or frequent flares) were identified, together with a control group frequency-matched by age and gender. Severe comorbidities were documented through ALD categories. Healthcare resource consumption was documented and valued from the payer's perspective. Rates of comorbidities and costs were compared in SpA patients versus controls using non-parametric testing.
Overall, 827 patients with ALD status for severe SpA were identified (control group: n=2.481), corresponding to a prevalence rate of 0.18% [0.17-0.19] for SpA with ALD in the general population. Severe comorbidities more frequent in patients with SpA than in controls included inflammatory bowel disorders (odds ratio: 15.0 [6.2-36.2]), hypertension (2.5 [1.6-3.9]), atrial fibrillation (4.3 [1.9-9.6]) and major depressive disorder (2.1 [1.3-3.6]). Mean per capita annual direct healthcare expenditure was 3.6 [3.2-4.1]-fold higher in SpA patients (€6,122 [€5,838-€6,406]) than in controls (€1,682 [€1,566-€1,798]). Extrapolating to all patients in France, total healthcare cost attributable to severe SpA patients was €391 [€355-€426] million, with medication accounting for 53.8% of this cost.
The burden of severe SpA in France is substantial, due to the high prevalence, high direct costs and associated comorbidities.
估算法国重度强直性脊柱炎（SpA）患者人数，描述其合并症，并记录和评估其医疗资源的消耗。
数据来自于涵盖法国 1/97 随机抽样人群的保险索赔数据库。于 2012 年确定所有符合重度 SpA 全额保险覆盖（ALD）条件的患者（包括有结构损伤和/或频繁发作的病例），并与按年龄和性别频数匹配的对照组进行比较。通过 ALD 类别记录重度合并症。从支付者角度记录和评估医疗资源消耗情况。使用非参数检验比较 SpA 患者与对照组的合并症发生率和费用。
共确定了 827 例 ALD 状态的重度 SpA 患者（对照组：n=2481），在普通人群中，ALD 状态的 SpA 患病率为 0.18%[0.17-0.19]。与对照组相比，SpA 患者中更常见的重度合并症包括炎症性肠病（比值比：15.0[6.2-36.2]）、高血压（2.5[1.6-3.9]）、心房颤动（4.3[1.9-9.6]）和重度抑郁障碍（2.1[1.3-3.6]）。SpA 患者的人均年直接医疗支出为 3.6[3.2-4.1]倍，为对照组（€6122[€5838-€6406]）的€6122[€5838-€6406]）。根据法国所有患者进行推算，重度 SpA 患者的总医疗费用为€391[€355-€426]百万元，药物治疗占该费用的 53.8%。
法国重度 SpA 的负担很重，这是由于其患病率高、直接费用高和相关合并症所致。
