Healthcare costs of pregnancy in systemic lupus erythematosus: retrospective observational analysis from a US health claims database
Healthcare costs of pregnancy in systemic lupus erythematosus: retrospective observational analysis from a US health claims database
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DOI：
10.3111/13696998.2015.1066796
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发表时间：
2015-11-02
影响因子：
2.4
通讯作者：
Pushparajah, D. S.
中科院分区：
文献类型：
--
作者：
Petri, M.;Daly, R. P.;Pushparajah, D. S.
目的：系统性红斑狼疮是一种复杂的自身免疫性疾病，好发于育龄妇女。患有狼疮的妇女患妊娠并发症的风险增加，这些并发症因活动性疾病而加剧。尽管如此，他们使用的药物和医院的资源还没有被广泛study.Methods：回顾性分析的Truven健康MarketScan数据库（2006-2012年），旨在量化药物和资源的利用在妊娠妇女狼疮，以及在这些患者的妊娠并发症的发生率。回顾了12-54岁妇女的记录，确定了狼疮患者和妊娠。与妊娠妇女狼疮1：5匹配，无论是孕妇没有狼疮，或非妊娠妇女lupus.Results：妊娠与狼疮与并发症增加相比，怀孕没有狼疮。在妊娠期间，狼疮孕妇使用免疫抑制剂的情况减少，风湿病医生的就诊也减少，而未接受任何免疫抑制剂治疗的妇女人数增加。患有狼疮的孕妇的总体治疗费用高于对照组。然而，与非妊娠女性狼疮相比，药物费用实际上下降，可能是由于这些患者或妇女成为怀孕，而疾病活动low.Conclusions的药物撤出：大型数据库分析报告显示，妊娠女性狼疮与并发症的风险更高，更高的医疗费用，和更少的处方药，包括免疫抑制剂，比对照组。并发症的风险增加和免疫抑制剂的使用减少表明，患者需要医生的额外指导，以使他们有最好的机会体验安全怀孕。事实上，尽管公认的作用积极狼疮在增加妊娠并发症中发挥作用，但患有狼疮的妇女在妊娠期间的风湿病就诊较少，尽管她们对全科医生/初级保健提供者的就诊增加，突出了妇产科医生和风湿病学家之间基于团队的协调护理的需要。
Objective:Systemic lupus erythematosus is a complex autoimmune disease, most frequently affecting women of childbearing age. Women with lupus are at increased risk of pregnancy complications that are exacerbated by active disease. Despite this, their use of medications and hospital resources has not been extensively studied.Methods:Retrospective analyses of the Truven Health MarketScan database (2006-2012) aimed to quantify drug and resource utilization in pregnant women with lupus, as well as the incidence of pregnancy complications in these patients. Records of women aged 12-54 were reviewed and both lupus patients and pregnancies identified. Pregnant women with lupus were matched 1:5 with either pregnant women without lupus, or non-pregnant women with lupus.Results:Pregnancies with lupus were associated with increased complications when compared to pregnancies without lupus. During pregnancy, the use of immunosuppressants decreased in pregnant women with lupus, as did rheumatologist visits, while the number of women not treated with any immunosuppressant increased. Pregnant women with lupus showed higher overall treatment costs than controls. However, compared to non-pregnant women with lupus, medication costs actually dropped, possibly due to the withdrawal of medications from these patients or women becoming pregnant while disease activity was low.Conclusions:The large database analyses reported here revealed that pregnancies in women with lupus were associated with a higher risk of complications, higher healthcare costs, and fewer prescribed medications, including immunosuppressants, than the control groups. The increased risk of complications and decreased immunosuppressant use suggest that patients require additional guidance from physicians to give them the best chance of experiencing a safe pregnancy. Indeed, despite the recognized role active lupus plays in increasing pregnancy complications, women with lupus had fewer rheumatology visits during pregnancy, although their visits to their general practitioner/primary healthcare provider increased, highlighting the need for team-based co-ordination care between OBGYN physicians and rheumatologists.