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Tan Y, Yu F, Long J, Gan L, Wang H, Zhang L, Zhao M. Frequency of Systemic Lupus Erythematosus Was Decreasing Among Hospitalized Patients From 2013 to 2017 in a National Database in China. Front Med (Lausanne) 2021; 8:648727. [PMID: 33889586 PMCID: PMC8056078 DOI: 10.3389/fmed.2021.648727] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 03/10/2021] [Indexed: 11/17/2022] Open
Abstract
Backgrounds: Limited data was reported for the frequency of SLE in China. The aim of this study was to investigate the frequency, geographical, and ethnic distributions of hospitalized SLE patients with data from the Hospital Quality Monitoring System (HQMS) in China. Methods: Hospitalized patients were investigated from a national inpatient database covering 46.0% of tertiary hospitals in China from 2013 to 2017. Data regarding the diagnosis of SLE were extracted based on ICD-10 codes. We collected and analyzed data from the front page of the records of inpatients, including frequency, demographic characteristics, and geographic distributions of SLE. Results: Among 158.3 million inpatients attended during the study period, 0.31% (491, 225) were diagnosed with SLE. The frequency of SLE decreased during the study period (from 0.30% in 2013 to 0.27% in 2017). The frequency of SLE increased with latitude (0.21% in northern China and 0.39% in southern China in 2017). Hospitalizations mostly occurred in winter (31.24%). The Li population had the highest frequency of patients with SLE (0.76%). The all-cause in-hospital mortality rate of SLE decreased from 0.74% (255/34,746) in 2013 to 0.54% (295/54,168) in 2017. The percentage of SLE patients with infections increased from 3.14% in 2013 to 4.72% in 2017. The percentage of SLE patients with tumors and thrombosis also increased slightly from 0.85 and 1.43% in 2013 to 1.27 and 2.45% in 2017, respectively. Conclusion: This study provided epidemiological information of SLE in hospitalized patients in China for the first time. An ethnic and spatial clustering trend of SLE was observed.
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Affiliation(s)
- Ying Tan
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.,Peking University Institute of Nephrology, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.,Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China.,Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Feng Yu
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.,Peking University Institute of Nephrology, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.,Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China.,Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China.,Department of Nephrology, Peking University International Hospital, Beijing, China
| | - Jianyan Long
- China Standard Medical Information Research Center, Shenzhen, China
| | - Lanxia Gan
- China Standard Medical Information Research Center, Shenzhen, China
| | - Haibo Wang
- China Standard Medical Information Research Center, Shenzhen, China
| | - Luxia Zhang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.,Peking University Institute of Nephrology, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.,Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China.,Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China.,Center for Data Science in Health and Medicine, Peking University, Beijing, China
| | - Minghui Zhao
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China.,Peking University Institute of Nephrology, Beijing, China.,Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.,Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, China.,Research Units of Diagnosis and Treatment of Immune-mediated Kidney Diseases, Chinese Academy of Medical Sciences, Beijing, China.,Peking-Tsinghua Center for Life Sciences, Beijing, China
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Ogunsanya ME, Nduaguba SO, Brown CM. Incremental health care services and expenditures associated with depression among individuals with cutaneous lupus erythematosus (CLE). Lupus 2018. [DOI: 10.1177/0961203318762604] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objectives The objective of this paper is to describe the annual direct medical expenditures for cutaneous lupus erythematosus (CLE) patients, and to estimate the incremental health care expenditures and utilization associated with depression among adults with CLE, while controlling for covariates. Methods Using the 2014 Medical Expenditure Panel Survey (MEPS), we compared CLE patients with and without depression to determine differences in: (a) health care utilization—inpatient, outpatient, office-based and emergency room (ER) visits, and prescriptions filled; and (b) expenditures—total costs, inpatient, outpatient, office-based, ER, and prescription medication costs, and other costs using demography-adjusted and comorbidity-adjusted multivariate models (age, gender, race/ethnicity, marital status, education, perception of health status, poverty category, smoking status, and Charlson Comorbidity Index). Results The total direct medical expenditure associated with CLE is estimated at approximately $29.7 billion in 2014 US dollars. After adjusting for covariates, adults with CLE and depression had more hospital discharges (utilization ratio (UR) = 1.13, 95% confidence interval (CI) (1.00–1.28)), ER visits (UR = 1.17, 95% CI (1.09–1.37)), and prescribed medicines (UR = 2.15, 95% CI (1.51–3.05)) than those without depression. Adults with CLE and depression had significantly higher average annual total expenditure that those without depression ($19,854 vs. $9735). Conclusions High health care expenditures are significant for patients with CLE, especially among those with depression. Prescription drugs, inpatient visits, and ER visits contributed most to the total expenditures in CLE patients with depression. Early diagnosis and treatment of depression in CLE patients may reduce total health care expenditures and utilization in this population.
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Affiliation(s)
- M E Ogunsanya
- College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - S O Nduaguba
- College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
| | - C M Brown
- College of Pharmacy, The University of Texas at Austin, Austin, TX, USA
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Bertsias G, Karampli E, Sidiropoulos P, Gergianaki I, Drosos A, Sakkas L, Garyfallos A, Tzioufas A, Vassilopoulos D, Tsalapaki C, Sfikakis P, Panopoulos S, Athanasakis K, Perna A, Psomali D, Kyriopoulos J, Boumpas D. Clinical and financial burden of active lupus in Greece: a nationwide study. Lupus 2016; 25:1385-94. [DOI: 10.1177/0961203316642310] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Accepted: 03/08/2016] [Indexed: 11/16/2022]
Abstract
Analyses of the medical and economic burden of chronic disorders such as systemic lupus erythematosus (SLE) are valuable for clinical and health policy decisions. We performed a chart-based review of 215 adult SLE patients with active autoantibody-positive disease at the predefined ratio of 30% severe (involvement of major organs requiring treatment) and 70% non-severe, followed at seven hospital centres in Greece. We reviewed 318 patients consecutively registered over three months (sub-study). Disease activity, organ damage, flares and healthcare resource utilization were recorded. Costs were assessed from the third-party payer perspective. Severe SLE patients had chronic active disease more frequently (22.4% vs 4.7%), higher average SLE disease activity index (SLEDAI) (10.5 vs 6.1) and systemic lupus international collaborating clinics (SLICC) damage index (1.1 vs 0.6) than non-severe patients. The mean annual direct medical cost was €3741 for severe vs €1225 for non-severe patients. Severe flares, active renal disease and organ damage were independent cost predictors. In the sub-study, 19% of unselected patients were classified as severe SLE, and 30% of them had chronic active disease. In conclusion, this is the first study to demonstrate the significant clinical and financial burden of Greek SLE patients with active major organ disease. Among them, 30% display chronic activity, in spite of standard care, which represents a significant unmet medical need.
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Affiliation(s)
- G Bertsias
- Rheumatology, Clinical Immunology and Allergy, University of Crete School of Medicine, Heraklion, Greece
| | - E Karampli
- Department of Health Economics, National School of Public Health, Athens, Greece
| | - P Sidiropoulos
- Rheumatology, Clinical Immunology and Allergy, University of Crete School of Medicine, Heraklion, Greece
| | - I Gergianaki
- Rheumatology, Clinical Immunology and Allergy, University of Crete School of Medicine, Heraklion, Greece
| | - A Drosos
- Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - L Sakkas
- Department of Medicine/Rheumatology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - A Garyfallos
- Fourth Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - A Tzioufas
- Department of Pathophysiology, University of Athens Medical School, Athens, Greece
- Joint Rheumatology Programme, Faculty of Medicine, University of Athens Medical School, Athens, Greece
| | - D Vassilopoulos
- Second Department of Medicine, Hippokration General Hospital, University of Athens Medical School, Athens, Greece
- Joint Rheumatology Programme, Faculty of Medicine, University of Athens Medical School, Athens, Greece
| | - C Tsalapaki
- Second Department of Medicine, Hippokration General Hospital, University of Athens Medical School, Athens, Greece
| | - P Sfikakis
- Joint Rheumatology Programme, Faculty of Medicine, University of Athens Medical School, Athens, Greece
- First Department of Propaedeutic/Internal Medicine, University of Athens Medical School, Laiko General Hospital, Athens, Greece
| | - S Panopoulos
- First Department of Propaedeutic/Internal Medicine, University of Athens Medical School, Laiko General Hospital, Athens, Greece
| | - K Athanasakis
- Department of Health Economics, National School of Public Health, Athens, Greece
| | - A Perna
- Global Specialty Pharma Franchise, GlaxoSmithKline, London, UK
| | | | - J Kyriopoulos
- Department of Health Economics, National School of Public Health, Athens, Greece
| | - D Boumpas
- Joint Rheumatology Programme, Faculty of Medicine, University of Athens Medical School, Athens, Greece
- Fourth Department of Medicine, Attikon University Hospital, University of Athens Medical School, Athens, Greece
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Holloway L, Humphrey L, Heron L, Pilling C, Kitchen H, Højbjerre L, Strandberg-Larsen M, Hansen BB. Patient-reported outcome measures for systemic lupus erythematosus clinical trials: a review of content validity, face validity and psychometric performance. Health Qual Life Outcomes 2014; 12:116. [PMID: 25048687 PMCID: PMC4223409 DOI: 10.1186/s12955-014-0116-1] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 07/08/2014] [Indexed: 01/30/2023] Open
Abstract
Background Despite overall progress in treatment of autoimmune diseases, patients with systemic lupus erythematosus (SLE) experience many inflammatory symptoms representing an unmet medical need. This study aimed to create a conceptual model of the humanistic and economic burden of SLE, and review the patient-reported outcomes (PROs) used to measure such concepts in SLE clinical trials. Methods A conceptual model for SLE was developed from structured review of published articles from 2007 to August 2013 identified from literature databases (MEDLINE, EMBASE, PsycINFO, EconLit) plus other sources (PROLabels, FDA/EMA websites, Clinicaltrials.gov). PROs targeting key symptoms/impacts were identified from the literature. They were reviewed in the context of available guidance and assessed for face and content validity and psychometric properties to determine appropriateness for use in SLE trials. Results The conceptual model identified fatigue, pain, cognition, daily activities, emotional well-being, physical/social functioning and work productivity as key SLE concepts. Of the 68 articles reviewed, 38 reported PRO data. From these and the other sources, 15 PROs were selected for review, including SLE-specific health-related quality of life (HRQoL) measures (n = 5), work productivity (n = 1), and generic measures of fatigue (n = 3), pain (n = 2), depression (n = 2) and HRQoL (n = 2). The Functional Assessment of Chronic Illness Therapy - Fatigue Scale (FACIT-Fatigue), Brief Pain Inventory (BPI-SF) and LupusQoL demonstrated the strongest face validity, conceptual coverage and psychometric properties measuring key concepts in the conceptual model. All PROs reviewed, except for three Lupus-specific measures, lacked qualitative SLE patient involvement during development. The Hospital Anxiety and Depression Scale (HADS), Short Form [36 item] Health Survey version 2 (SF-36v2), EuroQoL 5-dimensions (EQ-5D-3L and EQ-5D-5L) and Work Productivity and Activity Impairment Questionnaire: Lupus (WPAI:Lupus) showed suitability for SLE economic models. Conclusions Based on the identification of key symptoms and impacts of SLE using a scientifically sound conceptual model, we conclude that SLE is a condition associated with high unmet need and considerable burden to patients. This review highlights the availability and need for disease-specific and generic patient-reported measures of relevant domains of disease signs and symptoms, HRQoL and work productivity, providing useful insight for SLE clinical trial design.
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Cho JH, Chang SH, Shin NH, Choi BY, Oh HJ, Yoon MJ, Lee EY, Lee EB, Lee TJ, Song YW. Costs of illness and quality of life in patients with systemic lupus erythematosus in South Korea. Lupus 2014; 23:949-57. [PMID: 24563501 DOI: 10.1177/0961203314524849] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 01/27/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess the costs of illness, health-related quality of life (HRQOL) and their associated factors in patients with systemic lupus erythematosus (SLE) in South Korea. METHOD Two hundred and one patients with SLE were enrolled at the Rheumatology clinic of Seoul National University Hospital. Direct, indirect and total costs and HRQOL were measured using hospital electronic data and face-to-face interview. Socio-demographic and clinical factors associated with cost of illness and HRQOL were analyzed using multiple regression and multivariate logistic regression. RESULTS The average total cost of illness was estimated to be KRW 9.82 million (US $ 8993) per year, of which 41.6% was accounted for by direct costs and 58.4% by indirect costs. In multivariate regression, patients with renal involvement and those with depression incurred an average increment in annual total costs of 37.6% (p = 0.050) and 49.1% (p = 0.024), respectively, and an average increment in annual direct costs of 26.4% (p = 0.050) and 43.3% (p = 0.002), respectively, compared with patients without renal involvement and depression, respectively. In addition, disease damage was positively associated with an average increment in annual total and direct costs (55.3%, p = 0.006; 33.3%, p = 0.013, respectively), and the occurrence of indirect costs (OR 2.21, 1.09-4.88). There was no significant difference in HRQOL between patients with and without renal involvement (0.655 vs. 0.693, p = 0.203) CONCLUSION: Renal involvement, depression, and disease damage were major factors associated with higher total and medical costs for patients with SLE in South Korea. Effective treatment of renal disorders and depression may reduce the high economic burden of SLE.
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Affiliation(s)
- J H Cho
- Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - S H Chang
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - N H Shin
- Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - B Y Choi
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - H J Oh
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - M J Yoon
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - E Y Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - E B Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - T J Lee
- Graduate School of Public Health, Seoul National University, Seoul, Korea
| | - Y W Song
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology and College of Medicine, Medical Research Center, Seoul National University, Seoul, Korea
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