Annual Direct Cost and Cost-Drivers of Systemic Lupus Erythematosus: A Multi-Center Cross-Sectional Study from CSTAR Registry
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Data Collection
2.3. Measurements
2.4. Direct Cost Calculation
2.5. Statistical Analysis
3. Results
3.1. Socio-Demographic and Clinical Characteristics
3.2. Direct Cost of SLE Patients
3.3. Cost-Driving Factors
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Total (n = 1778) | |
---|---|
Age (years), mean (SD) | 33.8 (10.8) |
Gender, females, n (%) | 1646 (92.58%) |
Disease duration (years), median (p25–p75) | 4.9 (1.8–9.5) |
Newly treated patients, n (%) | 133 (7.48%) |
Regions | |
Western | 372 (20.92%) |
Central | 429 (24.13%) |
Eastern | 977 (54.95%) |
Medical insurance, n (%) | 1508 (84.81%) |
Patients’ incomes during last year (CNY), median (p25–p75) | 27,600 (0–50,000) |
Numbers of outpatient visits during last year, median (p25–p75) | 5 (3–8) |
Hospitalization during last year, n (%) | 345 (19.40%) |
Hospitalization days for inpatients, median (p25–p75) | 11 (7–17) |
Positive antinuclear antibody (ANA), n (%) | 1691 (95.11%) |
Positive anti-double-stranded DNA (dsDNA), n (%) | 1359 (76.43%) |
Abnormal liver function, n (%) | 380 (21.37%) |
Low complement, n (%) | 511 (28.74%) |
Physician’s global assessment, median (p25–p75) | 0.80 (0.40–1.10) |
SLEDAI scores, median (p25–p75) | 2.00 (0–4.00) |
Severity of the disease, n (%) | |
Mild (SLEDAI score < 8) | 1600 (89.99%) |
Moderate to severe (SLEDAI score ≥ 8) | 178 (10.01%) |
Disease activity state, n (%) | |
Remission or LLDAS | 643 (36.16%) |
Active disease | 1135 (63.84%) |
System involvement, n (%) | |
Peripheral vascular system | 919 (51.69%) |
Serositis | 740 (41.62%) |
Skin system | 1154 (64.90%) |
Musculoskeletal system | 942 (52.98%) |
Renal system | 685 (38.53%) |
Neuropsychiatric system | 115 (6.47%) |
Gastrointestinal system | 38 (2.14%) |
Ocular system | 22 (1.24%) |
Cardiovascular system | 127 (7.14%) |
Pulmonary system | 17 (0.96%) |
Number of organs damaged, n (%) | |
0 or 1 | 404 (22.72%) |
2 or more | 1374 (77.28%) |
Treatment of biologics, n (%) | 148 (8.32%) |
Treatment of glucocorticoids, n (%) | 1442 (81.10%) |
0 mg/day (none) | 336 (18.90%) |
≤7.5mg/day | 533 (29.98%) |
>7.5 and ≤15 mg/day | 510 (28.68%) |
>15 mg/day | 399 (22.44%) |
Annual Direct Medical Cost | Annual Direct Non-Medical Cost | Total Annual Direct Cost | |
---|---|---|---|
Mean ± SD | 25,520 ± 49,592 | 4298 ± 10,938 | 29,818 ± 53,389 |
Median (p25–p75) | 11,698 (4869–25,644) | 1650 (568–4270) | 14,867 (6820–31,180) |
Arithmetic mean (bootstrap) | 25,429 | 4298 | 29,727 |
Bootstrap 95% CI | 23,346 to 27,733 | 3745 to 4762 | 27,384 to 32,319 |
Proportion of total direct cost | 85.5% | 14.5% | 100% |
Features | N | Arithmetic Mean (Bootstrap) | 95% CI (Bootstrap) | Median (IQR) | p-Value * |
Gender | 0.81 | ||||
Male | 132 | 27,225 | 21,270–33,300 | 15,424 (5429–24,578) | |
Female | 1646 | 29,928 | 27,470–32,730 | 14,833 (6920–30,764) | |
Age groups | 0.50 | ||||
<18 years | 55 | 36,347 | 11,533–53,543 | 17,720 (7968–33,000) | |
18–39 years | 1268 | 29,417 | 26,473–32,453 | 14,292 (6899–29,717) | |
≥40 years | 455 | 29,785 | 25,722–33,671 | 15,275 (6522–35,093) | |
Disease duration | <0.001 | ||||
≤3 years | 651 | 35,064 | 30,794–39,189 | 18,120 (8405–38,090) | |
3–8 years | 555 | 26,454 | 21,568–31,057 | 12,276 (5875–26,264) | |
>8 years | 572 | 26,822 | 23,033–30,352 | 12,836 (6349–30,263) | |
Newly treated patients | <0.001 | ||||
Yes | 133 | 37,870 | 29,540–45,038 | 25,162 (9231–48,000) | |
No | 1645 | 29,071 | 26,578–31,755 | 14,165 (6650–30,223) | |
Region | 0.24 | ||||
Western | 372 | 31,075 | 26,530–35,979 | 16,558 (7315–32,999) | |
Central | 429 | 29,057 | 24,463–33,994 | 14,232 (6772–30,048) | |
Eastern | 977 | 29,507 | 25,908–32,796 | 13,912 (6724–30,760) | |
Health insurance | 0.85 | ||||
No | 270 | 28,369 | 22,106–33,699 | 14,158 (7433–30,223) | |
Yes | 1508 | 29,972 | 27,317–32,814 | 14,970 (6656–31,496) | |
Hospitalization during last year | <0.001 | ||||
Yes | 345 | 64,755 | 56,272–72,590 | 40625 (23,272–71,727) | |
No | 1433 | 21,289 | 19,089–23,483 | 11,436 (5667–22,384) | |
ANA | 0.01 | ||||
Positive | 1691 | 30,301 | 27,838–33,020 | 15,231 (7000–32,100) | |
Negative | 87 | 18,556 | 12,889–23,761 | 10,401 (5040–24,200) | |
dsDNA | 0.53 | ||||
Positive | 1359 | 29,613 | 27,178–32,371 | 14,833 (6950–31,385) | |
Negative | 419 | 30,093 | 23,515–35,909 | 15,450 (6348–30,280) | |
Abnormal liver function | 0.04 | ||||
Yes | 380 | 31,398 | 26,219–36,323 | 16,879 (7473–35,901) | |
No | 1398 | 29,272 | 26,268–32,177 | 14,072 (6566–30,512) | |
Low complement | 0.07 | ||||
Yes | 511 | 33,279 | 28,820–38,023 | 16,379 (6922–34,707) | |
No | 1267 | 28,299 | 25,529–31,295 | 14,232 (6800–30,312) | |
Severity of the disease | <0.001 | ||||
Mild | 1600 | 27,498 | 25,136–30,097 | 13,755 (6576–29,213) | |
Moderate to severe | 178 | 49,720 | 39,578–59,592 | 27,269 (11,730–55,497) | |
Disease Activity State | <0.001 | ||||
Remission or LLDAS | 643 | 21,337 | 18,932–23,841 | 10,600 (5006–23,220) | |
Active disease | 1135 | 34,492 | 31,095–38,342 | 17,500 (8216–36,454) | |
System involvement | |||||
Skin system | 0.67 | ||||
Normal | 624 | 30,645 | 25,997–35,103 | 15,167 (6872–31,724) | |
Abnormal | 1154 | 29,231 | 26,454–32,076 | 14,549 (6800–31,040) | |
Musculoskeletal system | 0.88 | ||||
Normal | 836 | 30,730 | 26,796–34,904 | 15,264 (6749–31,949) | |
Abnormal | 942 | 28,839 | 26,029–31,797 | 14,782 (6920–30,428) | |
Peripheral vascular system | <0.001 | ||||
Normal | 859 | 24,699 | 22,318–27,395 | 12,511 (6155–26,460) | |
Abnormal | 919 | 34,432 | 29,980–38,455 | 17,243 (7394–35,712) | |
Serositis | <0.001 | ||||
Normal | 1038 | 25,254 | 22,088–28,390 | 12,501 (6150–25,750) | |
Abnormal | 740 | 35,994 | 32,291–40,338 | 18,350 (7940–40,312) | |
Renal system | <0.001 | ||||
Normal | 1093 | 25,864 | 22,770–28,962 | 13,030 (6095–27,114) | |
Abnormal | 685 | 35,879 | 32,177–40,254 | 17,990 (7980–37,958) | |
Neuropsychiatric system | 0.47 | ||||
Normal | 1663 | 29,014 | 26,758–31,551 | 14,743 (6772–31,000) | |
Abnormal | 115 | 40,069 | 25,188–53,849 | 15,738 (7050–37,958) | |
Gastrointestinal system | 0.30 | ||||
Normal | 1740 | 29,344 | 26,945–31,906 | 14,833 (6851–30,900) | |
Abnormal | 38 | 47,167 | 21,122–67,857 | 17,645 (6520–51,660) | |
Ocular system | 0.46 | ||||
Normal | 1756 | 29,649 | 27,211–32,287 | 14,833 (6801–31,080) | |
Abnormal | 22 | 35,918 | 14,917–53,009 | 17,754 (8000–40,618) | |
Cardiovascular system | <0.001 | ||||
Normal | 1651 | 29,069 | 26,664–31,689 | 14,100 (6559–30,428) | |
Abnormal | 127 | 38,321 | 28,127–46,539 | 19,935 (11,220–43,701) | |
Pulmonary system | 0.04 | ||||
Normal | 1761 | 29,499 | 27,153–32,159 | 14,743 (6803–31,120) | |
Abnormal | 17 | 53,274 | 23,230–79,140 | 26,784 (13,345–98,400) | |
Number of Organs damaged | <0.001 | ||||
0 or 1 | 404 | 23,048 | 17,132–27,992 | 12,105 (5825–23,546) | |
2 or more | 1374 | 31,693 | 28,941–34,647 | 15,761 (7196–34,334) | |
Biologics | <0.001 | ||||
Yes | 148 | 48,817 | 33,271–60,434 | 26,890 (11,770–55,241) | |
No | 1630 | 27,996 | 25,868–30,462 | 13,755 (6559–29,500) | |
Dose of Glucocorticoids | <0.001 | ||||
0 mg/day (Unused) | 336 | 23,515 | 19,851–26,974 | 11,884 (5483–26,238) | |
≤7.5mg/day | 533 | 18,903 | 16,665–21,050 | 11,050 (5244–20,589) | |
>7.5mg/d and ≤15mg/day | 510 | 34,280 | 29,092–39,751 | 16,340 (7941–35,712) | |
>15mg/day | 399 | 43,608 | 35,702–50,329 | 23,270 (10,953–48,216) |
Univariate Linear Regression Model | Multiple Linear Regress Model (Method: Full) | Multiple Linear Regress Model (Method: Stepwise) | % of Increments or Decrements (Stepwise) | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
β | SE | p-Value | β | SE | p-Value | β | SE | p-Value | % * | Amount (CNY) # | |
Intercept | N. A | N. A | N. A | 8.49 | 0.36 | <0.01 | 8.99 | 0.16 | <0.01 | — | 8022 (ref) |
Female (ref = Male) | 0.06 | 0.11 | 0.56 | 0.12 | 0.09 | 0.21 | |||||
Age groups (ref: ≥40 years) | |||||||||||
<18 years | 0.10 | 0.17 | 0.53 | −0.03 | 0.15 | 0.82 | |||||
18–39 years | −0.04 | 0.06 | 0.53 | −0.07 | 0.06 | 0.23 | |||||
Disease duration (ref = ≤3 years) | |||||||||||
3–8 years | −0.36 | 0.07 | <0.01 | −0.08 | 0.07 | 0.23 | |||||
>8 years | −0.31 | 0.07 | <0.01 | −0.10 | 0.07 | 0.15 | |||||
Region (ref: West) | |||||||||||
Central | −0.12 | 0.08 | 0.15 | −0.09 | 0.07 | 0.21 | |||||
Eastern | −0.11 | 0.07 | 0.13 | −0.13 | 0.07 | 0.04 | |||||
Health insurance (ref: None) | −0.03 | 0.08 | 0.67 | −0.15 | 0.07 | 0.03 | −0.13 | 0.07 | 0.04 | −12.2 | −978 |
Hospitalization during last year (ref: None) | 1.32 | 0.06 | <0.01 | 1.19 | 0.06 | <0.01 | 1.22 | 0.06 | <0.01 | 238.7 | 19,150 |
Newly treated patients (ref: Treated patients) | 0.36 | 0.11 | <0.01 | −0.02 | 0.10 | 0.84 | |||||
ANA positive (ref: Negative) | 0.30 | 0.13 | 0.02 | 0.20 | 0.11 | 0.08 | |||||
dsDNA positive (ref: Negative) | 0.04 | 0.07 | 0.54 | 0.04 | 0.06 | 0.53 | |||||
Abnormal liver function (ref: Normal) | 0.13 | 0.07 | 0.06 | 0.05 | 0.06 | 0.43 | |||||
Low complement (ref: No) | 0.11 | 0.06 | 0.08 | −0.03 | 0.06 | 0.63 | |||||
Moderate to severe (ref: Mild) | 0.60 | 0.09 | <0.01 | 0.27 | 0.09 | <0.01 | 0.26 | 0.08 | <0.01 | 29.7 | 2382 |
Active disease State (ref: Remission or LLDAS) | 0.46 | 0.06 | <0.01 | 0.06 | 0.08 | 0.47 | |||||
System involvement | |||||||||||
Skin system (ref: Normal) | −0.02 | 0.06 | 0.71 | −0.01 | 0.06 | 0.83 | |||||
Musculoskeletal system (ref: Normal) | −0.01 | 0.06 | 0.87 | −0.03 | 0.05 | 0.60 | |||||
Peripheral vascular system (ref: Normal) | 0.22 | 0.06 | <0.01 | 0.12 | 0.05 | 0.02 | 0.13 | 0.05 | <0.01 | 13.9 | 1114 |
Serositis (ref: Normal) | 0.33 | 0.06 | <0.01 | 0.01 | 0.10 | 0.90 | |||||
Renal system (ref: Normal) | 0.30 | 0.06 | <0.01 | 0.20 | 0.10 | 0.04 | 0.20 | 0.05 | <0.01 | 22.1 | 1776 |
Neuropsychiatric system (ref: Normal) | 0.10 | 0.11 | 0.38 | 0.01 | 0.10 | 0.94 | |||||
Gastrointestinal system (ref: Normal) | 0.26 | 0.19 | 0.17 | 0.13 | 0.17 | 0.45 | |||||
Ocular system (ref: Normal) | 0.22 | 0.25 | 0.38 | 0.10 | 0.22 | 0.65 | |||||
Cardiovascular system (ref: Normal) | 0.43 | 0.11 | <0.01 | 0.42 | 0.10 | <0.01 | 0.39 | 0.09 | <0.01 | 47.7 | 3826 |
Pulmonary system (ref: Normal) | 0.65 | 0.29 | 0.02 | 0.26 | 0.25 | 0.30 | |||||
2 or more damaged organs (ref: 0 or 1) | 0.25 | 0.07 | <0.01 | −0.01 | 0.08 | 0.89 | |||||
Biologics (ref: Unused) | 0.59 | 0.10 | <0.01 | 0.34 | 0.09 | <0.01 | 0.34 | 0.09 | <0.01 | 40.5 | 3248 |
Glucocorticoids (ref: Unused) | |||||||||||
≤7.5mg/day | −0.09 | 0.08 | 0.24 | −0.01 | 0.07 | 0.92 | −0.02 | 0.07 | 0.73 | −2.0 | −159 |
>7.5mg/d and ≤15mg/day | 0.34 | 0.08 | <0.01 | 0.19 | 0.09 | 0.04 | 0.23 | 0.07 | <0.01 | 25.9 | 2074 |
>15mg/day | 0.60 | 0.08 | <0.01 | 0.24 | 0.10 | 0.01 | 0.30 | 0.08 | <0.01 | 35.0 | 2807 |
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Wang, H.; Li, M.; Zou, K.; Wang, Y.; Jia, Q.; Wang, L.; Zhao, J.; Wu, C.; Wang, Q.; Tian, X.; et al. Annual Direct Cost and Cost-Drivers of Systemic Lupus Erythematosus: A Multi-Center Cross-Sectional Study from CSTAR Registry. Int. J. Environ. Res. Public Health 2023, 20, 3522. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph20043522
Wang H, Li M, Zou K, Wang Y, Jia Q, Wang L, Zhao J, Wu C, Wang Q, Tian X, et al. Annual Direct Cost and Cost-Drivers of Systemic Lupus Erythematosus: A Multi-Center Cross-Sectional Study from CSTAR Registry. International Journal of Environmental Research and Public Health. 2023; 20(4):3522. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph20043522
Chicago/Turabian StyleWang, Haiyan, Mengtao Li, Kaiwen Zou, Yilin Wang, Qiaoling Jia, Li Wang, Jiuliang Zhao, Chanyuan Wu, Qian Wang, Xinping Tian, and et al. 2023. "Annual Direct Cost and Cost-Drivers of Systemic Lupus Erythematosus: A Multi-Center Cross-Sectional Study from CSTAR Registry" International Journal of Environmental Research and Public Health 20, no. 4: 3522. https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph20043522