A. Aguirre, MD, M. Dall'Era, MD, J. Yazdany, MD, MPH, Division of Rheumatology, University of California, San Francisco, California;
K. DeQuattro, MD, Division of Rheumatology, University of Pennsylvania, Pennsylvania.
J Rheumatol. 2023 Oct;50(10):1302-1309. doi: 10.3899/jrheum.2023-0060. Epub 2023 Jun 15.
Concerns about the affordability of medications are common in systemic lupus erythematosus (SLE), but the relationship between medication cost concerns and health outcomes is poorly understood. We assessed the association of self-reported medication cost concerns and patient-reported outcomes (PROs) in a multiethnic SLE cohort.
The California Lupus Epidemiology Study is a cohort of individuals with physician-confirmed SLE. Medication cost concerns were defined as having difficulties affording SLE medications, skipping doses, delaying refills, requesting lower-cost alternatives, purchasing medications outside the United States, or applying for patient assistance programs. Linear regression and mixed effects models assessed the cross-sectional and longitudinal association of medication cost concerns and PROs, respectively, adjusting for age, sex, race and ethnicity, income, principal insurance, immunomodulatory medications, and organ damage.
Of 334 participants, medication cost concerns were reported by 91 (27%). Medication cost concerns were associated with worse Systemic Lupus Activity Questionnaire (SLAQ; beta coefficient [β] 5.9, 95% CI 4.3-7.6; < 0.001), 8-item Patient Health Questionnaire depression scale (PHQ-8; β 2.7, 95% CI 1.4-4.0; < 0.001), and Patient-Reported Outcomes Measurement Information System (PROMIS; β for physical function -4.6, 95% CI -6.7 to -2.4; < 0.001) scores after adjusting for covariates. Medication cost concerns were not associated with significant changes in PROs over 2-year follow-up.
More than a quarter of participants reported at least 1 medication cost concern, which was associated with worse PROs. Our results reveal a potentially modifiable risk factor for poor outcomes rooted in the unaffordability of SLE care.
人们普遍对系统性红斑狼疮（SLE）药物的可负担性表示担忧，但药物费用问题与健康结果之间的关系尚不清楚。我们评估了多民族 SLE 队列中自我报告的药物费用问题与患者报告的结局（PRO）之间的关系。
加利福尼亚狼疮流行病学研究是一项经医生确诊为 SLE 的个体队列研究。药物费用问题被定义为难以负担 SLE 药物、漏服药物、延迟药物续开、要求提供更廉价的替代药物、在美国境外购买药物或申请患者援助计划。线性回归和混合效应模型分别评估了药物费用问题与 PRO 的横断面和纵向关联，调整了年龄、性别、种族和民族、收入、主要保险、免疫调节剂和器官损伤等因素。
在 334 名参与者中，有 91 名（27%）报告了药物费用问题。药物费用问题与系统性红斑狼疮活动问卷（SLAQ；β系数[β]5.9，95%置信区间 4.3-7.6；<0.001）、8 项患者健康问卷抑郁量表（PHQ-8；β 2.7，95%置信区间 1.4-4.0；<0.001）和患者报告的结局测量信息系统（PROMIS；β对于身体机能 -4.6，95%置信区间 -6.7 至 -2.4；<0.001）评分较差相关，在调整了协变量后。药物费用问题与 2 年随访期间 PRO 的显著变化无关。
超过四分之一的参与者报告了至少一种药物费用问题，这与 PRO 较差有关。我们的结果揭示了一种潜在的可改变的不良结局风险因素，其根源在于 SLE 治疗的不可负担性。
