Clarke A E, Bloch D A, Danoff D S, Esdaile J M
Division of Clinical Immunology and Allergy, Montreal General Hospital, McGill University, PQ, Canada.
J Rheumatol. 1994 Dec;21(12):2246-53.
To characterize patients with systemic lupus erythematosus (SLE) who are expected to experience the highest direct and indirect monetary costs and greatest diminished productivity so that we may intervene to reduce costs and improve outcomes.
We assessed demographics and health status in January, 1990 and costs incurred in the last 6 months of 1990 in January, 1991 in 151 patients with SLE enrolled in the Montreal General Hospital Lupus Registry. We used regression trees to separate low from high cost patients.
Patients with poor physical or poor psychological functioning incur the highest direct costs (3-fold and 1.6-fold the group mean, respectively); those with the poorest psychological functioning incur the highest indirect costs (2-fold the group average); and those with the most intense pain experience the greatest impairment in productivity (3-fold the group average).
Targeting patients with poor physical and psychological functioning and substantial pain with appropriate interventions may improve their outcomes and reduce disease costs. Targeting patients expected to have low costs with preventative interventions may delay worse outcomes and reduce future costs.
对系统性红斑狼疮（SLE）患者进行特征描述，这些患者预计会产生最高的直接和间接货币成本以及最大程度的生产力下降，以便我们能够进行干预以降低成本并改善治疗效果。
我们于1990年1月评估了151名纳入蒙特利尔综合医院狼疮登记处的SLE患者的人口统计学和健康状况，并于1991年1月评估了他们在1990年最后6个月产生的费用。我们使用回归树将低成本患者与高成本患者区分开来。
身体功能差或心理功能差的患者产生的直接成本最高（分别是组均值的3倍和1.6倍）；心理功能最差的患者产生的间接成本最高（是组均值的2倍）；而疼痛最剧烈的患者生产力受损最大（是组均值的3倍）。
针对身体和心理功能差且疼痛严重的患者进行适当干预，可能会改善他们的治疗效果并降低疾病成本。对预计成本较低的患者进行预防性干预，可能会延缓病情恶化并降低未来成本。
