Schultze Michael, Garal-Pantaler Elena, Pignot Marc, Levy Roger A, Carnarius Heike, Schneider Matthias, Gairy Kerry
Berlin Center for Epidemiology and Health Research, ZEG Berlin GmbH, Invalidenstr. 115, 10115, Berlin, Germany.
Health Care Research and Health Economics (Versorgungsforschung und Gesundheitsökonomie), Team Gesundheit GmbH, Rellinghauser Straße 93, 45128, Essen, Germany.
BMC Rheumatol. 2024 May 17;8(1):18. doi: 10.1186/s41927-024-00387-6.
Systemic lupus erythematosus (SLE), a chronic multisystem autoimmune disease, carries high risk of organ damage and burden to healthcare systems. SLE disease modification aims to reduce disease activity with minimal treatment toxicity and preventing or minimizing organ damage development. This real-world study utilizing healthcare administrative claims data assessed organ damage development, associated costs and healthcare resource utilization (HCRU) in patients with SLE in Germany.
Claims data from January 1, 2007, to December 31, 2017, were obtained from the Betriebskrankenkassen German Sickness Fund Database. Adults (> 18 years) with a confirmed SLE diagnosis between January 1, 2009, and December 31, 2014, (inclusion period) were included. The index date was calculated based on the first recorded SLE diagnosis during this period. Patients were propensity score-matched (1:3) to a comparator cohort without SLE by age, sex, and comorbidities (Charlson comorbidity index). Organ damage was identified using an algorithm developed based on conditions described in the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI), using ICD-10-GM diagnostic codes, healthcare procedures, and/or treatments.
2121 patients with SLE and 6308 comparator patients were included (mean follow-up time: 6.4 years). Organ damage prevalence increased from 60.5% at baseline to 83.0% during 6 years of follow-up in all patients with SLE, while 17.0% of patients with SLE did not develop organ damage. Patients with newly confirmed SLE diagnosis without organ damage at baseline were nearly twice as likely to develop organ damage within 5 years versus the comparator cohort (52.0% vs. 27.0%). Total annual costs per patient-year for patients with SLE with organ damage were more than double those of patients with SLE without organ damage; both the number of inpatient admissions and length of stay were higher.
The application of a recently developed algorithm allowed us to use claims data to elucidate SLE organ damage, and its associated high clinical and economic burden, in a large, representative sample in Germany. To our knowledge, this is the first European analysis of its kind involving a broad cohort of patients with SLE treated in the routine care setting.
系统性红斑狼疮（SLE）是一种慢性多系统自身免疫性疾病，具有较高的器官损害风险，给医疗系统带来沉重负担。SLE疾病改善旨在以最小的治疗毒性降低疾病活动度，并预防或减少器官损害的发生。这项利用医疗管理索赔数据的真实世界研究评估了德国SLE患者的器官损害发生情况、相关成本和医疗资源利用（HCRU）。
从德国企业健康保险基金数据库获取2007年1月1日至2017年12月31日的索赔数据。纳入2009年1月1日至2014年12月31日（纳入期）确诊为SLE的成年人（>18岁）。索引日期根据该期间首次记录的SLE诊断计算。通过年龄、性别和合并症（Charlson合并症指数）将患者与无SLE的对照队列进行倾向得分匹配（1:3）。使用基于系统性红斑狼疮国际协作临床/美国风湿病学会损伤指数（SDI）中描述的疾病、ICD-10-GM诊断代码、医疗程序和/或治疗开发的算法识别器官损害。
纳入2121例SLE患者和6308例对照患者（平均随访时间：6.4年）。所有SLE患者的器官损害患病率从基线时的60.5%在6年随访期间增至83.0%，而17.0%的SLE患者未发生器官损害。基线时新确诊且无器官损害的SLE患者在5年内发生器官损害的可能性几乎是对照队列的两倍（52.0%对27.0%）。有器官损害的SLE患者每年每位患者的总成本是无器官损害的SLE患者的两倍多；住院次数和住院时间均更高。
应用最近开发的算法使我们能够利用索赔数据在德国一个大型代表性样本中阐明SLE器官损害及其相关的高临床和经济负担。据我们所知，这是欧洲首次对在常规护理环境中接受治疗的广泛SLE患者队列进行的此类分析。
