Digital ulcers in systemic sclerosis: their epidemiology, clinical characteristics, and associated clinical and economic burden
Digital ulcers in systemic sclerosis: their epidemiology, clinical characteristics, and associated clinical and economic burden
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DOI：
10.1186/s13075-019-2080-y
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发表时间：
2019-12-23
影响因子：
4.9
通讯作者：
Nikpour, Mandana
中科院分区：
文献类型：
--
作者：
Morrisroe, Kathleen;Stevens, Wendy;Nikpour, Mandana
背景资料：为了确定系统性硬化症相关的数字溃疡的频率和临床特征，以及相关的直接医疗保健费用，生活质量和survival.Methods：数字溃疡（DU）被定义为一个视觉上可辨别的深度和上皮覆盖的连续性损失的区域。根据临床审查时医生报告的最高新发DU数量计算DU严重程度（轻度= 1-5 DU，中度6-10 DU，重度> 10 DU）。通过数据链接获取医疗保健使用情况，其中将专用临床数据库中前瞻性获取的SSc临床数据与卫生服务数据库链接，以获取2008-2015年期间的入院、急诊科（艾德）介绍和门诊护理（MBS）使用情况和成本。使用logistic regression.Results：在1085例SSc患者中，48.6%的患者在平均随访5.2 +/- 2.5年的时间内经历了DU。那些发展成DU的人更有可能患有弥漫性疾病亚型，（34.9% vs 18.2%，p < 0.001），抗Scl-70抗体（18.9% vs 9.3%，p < 0.001），以及SSc发作时的年龄较小（43.6 +/- 13.9 vs 48.8 +/- 14.0岁，p < 0.001），以及SF-36测量的健康相关生活质量（HRQoL）降低，但对生存期无显著影响。有DU病史的SSc患者每年使用的医疗资源显著多于无DU的患者，包括住院、艾德就诊和门诊护理服务。总的医疗保健服务，不包括药物，与每年的额外成本每DU患者AUD$12，474（8574- 25，677），p < 0.001，由入院和艾德介绍costs.Conclusion驱动：DU放置一个很大的负担，对病人和医疗保健系统，通过降低HRQoL和增加医疗资源的利用和相关的成本。
Background: To determine the frequency and clinical characteristics of systemic sclerosis-related digital ulcers, and associated direct health care costs, quality of life, and survival.Methods: Digital ulcers (DUs) were defined as an area with a visually discernible depth and a loss of continuity of epithelial coverage. DU severity was calculated based on the physician reported highest number of new DUs at clinical review (mild = 1-5 DUs, moderate 6-10 DUs, severe > 10 DUs). Healthcare use was captured through data linkage, wherein SSc clinical data captured prospectively in a dedicated clinical database were linked with health services databases to capture hospital admissions, emergency department (ED) presentations and ambulatory care (MBS) utilization and cost for the period 2008-2015. Healthcare cost determinants were estimated using logistic regression.Results: Among 1085 SSc patients, 48.6% experienced a DU over a mean follow-up of 5.2 +/- 2.5 years. Those who developed DUs were more likely to have diffuse disease subtype (34.9% vs 18.2%, p < 0.001), anti-Scl-70 antibody (18.9% vs 9.3%, p < 0.001), and a younger age at SSc onset (43.6 +/- 13.9 vs 48.8 +/- 14.0 years, p < 0.001) in addition to reduced health-related quality of life (HRQoL) measured by the SF-36 but without a significant impact on survival. SSc patients with a history of a DU utilized significantly more healthcare resources per annum than those without a DU, including hospitalizations, ED presentation, and ambulatory care services. Total healthcare services, excluding medications, were associated with an annual excess cost per DU patient of AUD$12,474 (8574-25,677), p < 0.001, driven by hospital admission and ED presentation costs.Conclusion: DUs place a large burden on the patient and healthcare system through reduced HRQoL and increased healthcare resource utilization and associated cost.