Faculty of Pharmaceutical Sciences, The University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada; Arthritis Research Canada, 5591 No. 3 Road, Richmond, BC V6X 2C7, Canada.
Faculty of Pharmaceutical Sciences, The University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC V6T 1Z3, Canada; Arthritis Research Canada, 5591 No. 3 Road, Richmond, BC V6X 2C7, Canada; School of Pharmacy, University of Otago, Dunedin, New Zealand.
Semin Arthritis Rheum. 2020 Feb;50(1):77-83. doi: 10.1016/j.semarthrit.2019.06.010. Epub 2019 Jun 14.
To assess the incremental direct medical costs of a population-based cohort of incident systemic lupus erythematosus (SLE) for the first five years after diagnosis, and impact of socioeconomic status (SES) on such incremental costs.
From the administrative health databases in British Columbia, Canada, we identified all adults with newly-diagnosed SLE from 1996 to 2010 and obtained a sample from the general non-SLE population matched on sex, age, and calendar-year. We captured costs for outpatient encounters, hospitalisations, and dispensed medications. Using two-part generalised linear models, we estimated per-person-year incremental costs of SLE (difference in costs between SLE and non-SLE, controlling for covariates) during the first five years after diagnosis, and assessed differences in incremental costs across SES groups.
We included 4679 newly-diagnosed SLE (86% identified from hospitalisations or rheumatologists) and 23,219 non-SLE individuals. Per-person direct costs for SLE in the first year after diagnosis averaged $13,038 (2013 Canadian), with 61% from hospitalisations, 23% from outpatient encounters, and 16% from medications; costs for non-SLE averaged $2,431. Following adjustment, incremental costs of SLE during the first five years after diagnosis averaged $10,078 per-person-year (95% CI=$2062-$32,254). Predicted incremental hospitalisation, outpatient, and medication costs were all significantly-greater for the low-SES patients versus high-SES (additional $1922 per-person-year in incremental costs for low-SES). Similar patterns were observed when restricting to those followed the full five-years after index date.
Even in a single-payer, publicly-funded healthcare setting, low SES at SLE diagnosis was associated with significantly-greater direct medical costs for the management of SLE and associated complications.
评估基于人群的系统性红斑狼疮（SLE）发病后五年内的增量直接医疗成本，并评估社会经济地位（SES）对这种增量成本的影响。
我们从加拿大不列颠哥伦比亚省的行政健康数据库中确定了所有 1996 年至 2010 年间新诊断为 SLE 的成年人，并从普通非 SLE 人群中选择了与性别、年龄和日历年份相匹配的样本。我们记录了门诊就诊、住院和配药的费用。使用两部分广义线性模型，我们估计了 SLE 患者（SLE 和非 SLE 之间的成本差异，控制了协变量）在诊断后五年内的人均年增量成本，并评估了 SES 组之间增量成本的差异。
我们纳入了 4679 例新诊断的 SLE（86%来自住院或风湿病学家）和 23219 例非 SLE 个体。SLE 患者在诊断后第一年的人均直接医疗费用为 13038 加元（2013 年加拿大元），其中 61%来自住院治疗，23%来自门诊就诊，16%来自药物治疗；非 SLE 患者的平均费用为 2431 加元。调整后，SLE 在诊断后五年内的增量成本平均为每人每年 10078 加元（95%CI=2062-32254）。预测的低收入 SES 患者的增量住院、门诊和药物治疗费用均显著高于高 SES 患者（低收入 SES 患者的增量成本每人每年增加 1922 加元）。在限制为在索引日期后完全随访五年的患者中，也观察到了类似的模式。
即使在单一支付者、公共资助的医疗保健环境中，SLE 诊断时的低 SES 与 SLE 管理和相关并发症的直接医疗费用显著增加有关。
