한국인 루푸스 환자의 임상 역학 및 의료비용에 관한 연구

Abstract

p=0.022) and renal system (18% vs. 9.3%; p=0.006). Among 766 SLE patients (4,530 person-years), a total of 29 cases of death were confirmed. In pSLE, lupus-related deaths were most frequent (57.1%) whereas, death related infections were most common in aSLE (32.0%). The cumulative probabilities of survival at 5, 10 years were 97.6%, 89.3% in pSLE, and 98.2%, 96.4% in aSLE. The probability of survival was significantly lower in pSLE (log rank; p=0.035). Compared with an age-, sex-, and calendar-matched general population, the SMR of patients with pSLE and aSLE were 50.0 (95% CI 20.1-103) and 4.8 (95% CI 3.1-7.4), respectively. In multivariate regression, shorter disease duration, higher disease activity, and higher disease damage were predictors of mortality for pSLE. In particular, neuropsychiatric damage (HR 3.8 vs. 96.6; p=0.0097) and hemolytic anemia (HR 2.5 vs. 22.5; p=0.0155) significantly increased the mortality for pSLE patients.

2) The estimated total annual direct medical costs amounted to $3,305 in 2010 US dollars, of which 60.4% was accounted for by inpatient costs and 39.6% by outpatient costs. Among the cost domains for total direct medical costs, the biggest component was the costs of medication. The mean medication costs were $1,251, which accounted for 38.4% of the total healthcare costs, followed by costs for diagnostic procedures and tests, accounting for 35.6% of the total. Total reimbursement rates of patients with SLE were 64.9%, and copayment and non-reimbursement comprised 9.4% and 25.7%, respectively. In the multivariate regression analyses, the predictors of increased direct costs were greater disease activity (as expressed by the adjusted mean SLEDAI score; AMS), greater organ damage (as expressed by the SDI score) and renal and hematologic involvement, whereas greater disease duration predicted lower direct costs.

Conclusions This is the first study in Korea that identifies the difference of clinical and immunologic features and outcomes between patients with pSLE and aSLE, and elucidates the medical costs and predictors. Our results demonstrate that the patients with pSLE have a higher rate of major organ involvement and a more aggressive clinical course. And, the patients with SLE incurred a mean annual direct cost of $3,305 in 2010 US dollars. Longer disease duration predicted lower costs, whereas greater disease activity, greater organ damage, and renal and hematologic involvement predicted higher costs.; Objectives The aims of this study was to investigate differences in clinical features and mortality between pediatric-onset systematic lupus erythematosus (pSLE) and adult-onset SLE (aSLE) and, to elucidate the medical direct costs and the predictors of cost in patients with SLE.

Methods A total of 972 SLE patients were enrolled in the Hanyang BAE’s lupus cohort in Seoul, Korea, between February 1998 and December 2010. For mortality analysis, only 766 of the 972 SLE patients enrolled up to 2008 were included, because mortality data were prepared by data linkage with the available data from the Korean National Statistical Office. For cost analysis, 749 patients, followed during 2010 included, and the annual direct costs for the 12 months in 2010. Information was taken directly from the chart review and hospital database. And, the medication costs, which are not available from hospital database, were obtained by micro-costing methodology.

Results 1) There were 111 (11.4%) pSLE patients and 861 (88.6%) aSLE patients. The female: male ratio in pSLE (3:1) is lower than that seen in aSLE (18:1). The duration of followup was similar in the two groups, with a 5.7 ± 3.7 years in the pSLE group and 5.6 ± 4.0 years in the aSLE group. The frequency of malar rash, photosensitivity, renal disorder, neurologic disorder and immunologic disorder in ACR criteria were significantly higher in pSLE patients. The mean SDI scores of 0.9 ± 1.4 in the pSLE group and 0.8 ± 1.3 in the aSLE group, and pSLE patients were more frequently affected in neuropsychiatric (14.4% vs. 8.4%