Faculty of Medicine, University of Helsinki, Helsinki, Finland.
Department of Dermatology and Allergology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland.
BMC Health Serv Res. 2021 Feb 22;21(1):166. doi: 10.1186/s12913-021-06109-9.
Information about health care use and costs of cutaneous T-cell lymphoma (CTCL) patients is limited, particularly in a European setting.
In this population-wide study we set out to investigate prevalence, and trends in health care use in two CTCL subtypes, mycosis fungoides (MF) and Sézary syndrome (SS) over a time period of 19 years in 1998-2016 by using a nation-wide patient register containing data on all diagnosed MF and SS cases in Finland.
The prevalence of diagnosed MF and SS rose from 2.04 to 5.38/100000, and from 0.16 to 0.36/100000 for MF and SS respectively during 1998-2016. We found a substantial decrease in inpatient treatment of MF/SS in the past two decades with a mean of 2 inpatient days/patient/year due to MF/SS in 2016, while the mean numbers of MF/SS related outpatient visits remained stable at 8 visits/year/patient. Most MF/SS-related outpatient visits occurred in the medical specialty of dermatology. In a ten-year follow-up after MF/SS diagnosis, the main causes for outpatient visits and inpatient stays were MF/SS itself, other cancers, and other skin conditions. Also cardiovascular disease and infections contributed to the number of inpatient days. Mean total hospital costs decreased from 11,600 eur/patient/year to 3600 eur/patient/year by year 4 of the follow-up, and remained at that level for the remainder of the 10-year follow-up. MF/SS accounted for approximately half of the hospital costs of these patients throughout the follow-up.
The nearly 3-fold increase in prevalence of diagnosed MF/SS during 1998-2016 puts pressure on the health care system, as this is a high-cost patient group with a heavy burden of comorbidities. The challenge can be in part answered by shifting the treatment of MF/SS to a more outpatient-based practice, and by adapting new pharmacotherapy, as has been done in Finland.
有关皮肤 T 细胞淋巴瘤（CTCL）患者的医疗保健使用和费用的信息有限，尤其是在欧洲环境下。
在这项全人群研究中，我们通过使用包含芬兰所有诊断为蕈样真菌病（MF）和 SS 病例数据的全国性患者登记处，旨在调查在 1998 年至 2016 年的 19 年期间，两种 CTCL 亚型 MF 和 SS 的患病率和医疗保健使用趋势。
1998 年至 2016 年，诊断为 MF 和 SS 的患病率从 2.04/100000 上升到 5.38/100000，MF 和 SS 分别从 0.16/100000 上升到 0.36/100000。我们发现，在过去的二十年中，MF/SS 的住院治疗大幅减少，2016 年平均每位患者/年因 MF/SS 住院 2 天，而 MF/SS 相关的门诊就诊次数保持稳定，每年 8 次/患者。大多数 MF/SS 相关的门诊就诊发生在皮肤科医学专业。在 MF/SS 诊断后的十年随访中，门诊和住院的主要原因是 MF/SS 本身、其他癌症和其他皮肤状况。此外，心血管疾病和感染也导致了住院天数的增加。总住院费用从随访第 4 年的每位患者/年 11600 欧元降至 3600 欧元，在 10 年随访的其余时间保持在该水平。在整个随访期间，MF/SS 约占这些患者住院费用的一半。
1998 年至 2016 年期间，诊断为 MF/SS 的患病率增加了近 3 倍，这给医疗保健系统带来了压力，因为这是一个高成本的患者群体，患有多种合并症。芬兰已经通过将 MF/SS 的治疗转移到更基于门诊的实践，并采用新的药物治疗，可以在一定程度上应对这一挑战。
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