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Glucocorticoid Use in Patients With Systemic Lupus Erythematosus: Association Between Dose and Health Care Utilization and Costs

Title
Glucocorticoid Use in Patients With Systemic Lupus Erythematosus: Association Between Dose and Health Care Utilization and Costs
Author
최찬범
Keywords
RESOURCE UTILIZATION; CORTICOSTEROID USE; ADVERSE EVENTS; MEDICAL COSTS; NEPHRITIS; POPULATION; IDENTIFICATION; EPIDEMIOLOGY; PREVALENCE; BURDEN
Issue Date
2015-08
Publisher
WILEY-BLACKWELL
Citation
ARTHRITIS CARE & RESEARCH, v. 67, NO 8, Page. 1086-1094
Abstract
ObjectiveTo investigate the determinants of health care utilization and costs with use of glucocorticoid (GC) drugs among adult systemic lupus erythematosus (SLE) patients. MethodsThis cross-sectional study analyzed established SLE patients identified by International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes from a large US insurance claims database in 2007-2011. Five patient groups were defined by their oral GC use during a 1-year period: non-GC users, <60 days of GC use, and 60 days of GC use in low dosage (7.5 mg/day), medium dosage (>7.5 to 15 mg/day), or higher dosage (>15 mg/day). Annual health care utilization and costs were compared across these groups. Incremental costs of GC groups, calculated as the difference in total health care costs compared with those of the non-GC group, were estimated from multivariable regressions adjusting for demographic/clinical characteristics and stratified by concomitant immunosuppressant use. ResultsA total of 50,230 SLE patients were identified (52% non-GC users, 20% <60 days of GC use, and 10% low dose, 10% medium dose, and 8% higher dose of 60 days of GC use). GC users had higher health care utilization and costs. Incremental costs were significant (all P < 0.01) for medium-dose ($5,319 and $6,913) and higher-dose ($12,517 and $15,019) GC groups, regardless of concomitant immunosuppressant use. The incremental costs for the low-dose GC group with concomitant immunosuppressants ($1,285; P=0.04) were smaller than the incremental costs for the low-dose GC group without concomitant immunosuppressants ($2,514; P < 0.01). ConclusionGC use, especially at higher doses, was associated with higher health care utilization and costs. Findings in users with concomitant immunosuppressants suggest that therapies with a GC-sparing effect may be associated with lower economic burden in SLE treatment.
URI
http://onlinelibrary.wiley.com/doi/10.1002/acr.22574/fullhttp://hdl.handle.net/20.500.11754/26908
ISSN
2151-464X; 2151-4658
DOI
10.1002/acr.22574
Appears in Collections:
COLLEGE OF MEDICINE[S](의과대학) > MEDICINE(의학과) > Articles
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