Abstract:Objective: Lupus nephritis is one of the most severe complications of systemic lupus erythematosus and it has been estimated that can occur in up to 60% of patients. Direct costs of lupus nephritis have not been studied in developing countries. This study aimed to describe lupus nephritis direct costs in Colombia. Methods: Administrative data from two Colombian health maintenance organizations for 2014 and 2015 was obtained. An algorithm based on the International Statistical Classification of Diseases and Rel… Show more
“…[6][7][8][9][10]31,32 Specially, patients with lupus nephritis contribute to a major economic burden comparing with lupus without nephritis. [11][12][13][14]33 Cumulative damage (highest SDI 34 scores) has also been described as a factor of increased disease costs, showing 10-year cumulative costs 9-fold higher than those with lower damage. 35 Data regarding economic burden of SLE are mainly from developed countries with scarce data from other countries.…”
Section: Discussionmentioning
confidence: 99%
“…32 Also in Colombia, annual costs for patients with lupus nephritis have been calculated to be 7.46 times greater than those without nephritis. 13 As far as we know, up to date there is no other data on SLE health care resource use from other Latin American countries and no data from Argentina. 46.4 (17.9) Follow-up time, years, median (IQR) 8.0 (5.0-12.4) Fulfilling 1997 ACR lupus criteria 23 , n (%) 46 (74.2) Fulfilling SLICC lupus criteria 24 , n (%) 62 (100) Charlson a score at diagnosis, median (IQR) 0 (0-2) Charlson a score at the end of follow-up, median (IQR) 1 (0-3) SLICC damage index score at the end of follow-up, median (IQR) 0 (0-2) Death, n (%) We found in our cohort that patients experienced the majority of the follow-up in a remission state (74.4% of the time), and the median time on remission was 62.5 months.…”
Section: Discussionmentioning
confidence: 99%
“…3 The economic burden of patients with SLE care has been addressed in some countries, 4,5 mainly estimating direct costs. Some studies have reported significant differences in costs generated by lupus patients with a severe disease [6][7][8][9][10] or with certain organ manifestations (renal/ neuropsychiatric) [11][12][13][14][15] in comparison with those with mild involvement.…”
Objective The aim is to analyze health care resource utilization (HCRU) of patients with lupus (SLE) from a health management organization (HMO) in Buenos Aires, Argentina, compared with matched controls and comparing periods of flare, low disease activity, and remission. Methods This is a retrospective observational study including all SLE incident cases (ACR 1997/SLICC 2012 criteria) between 2000 and 2020 and 5 matched controls. Clinical data and HCRU (medical and nonmedical consultations, lab and imaging tests performed, emergency room visits, hospitalizations, and drugs prescribed) were obtained from administrative databases and electronic medical records. For each patient with SLE, an activity state was determined in every month of follow-up: flare (BILAG A or 2 BILAG B); low disease activity (LLDAS); remission (DORIS definition); or intermediate activity (not fulfilling any of previous). Incidence rates for each HCRU item and incidence rate ratios between SLE and control patients were and between remission and flare periods were calculated. Multivariate negative binomial logistic regression analyses were performed for identification of variables associated with major resource use. Results A total of 62 SLE and 310 control patients were included, 88.7% were women, the median age at diagnosis was 46 years, and were followed for more than 8 years. Patients with SLE contributed with 537.2 patient-years (CI 95% 461.1–613.3) and controls with 2761.9 patient-years (CI 95% 2600.9–2922.8). HCRU in patients with SLE was significantly higher than in controls in all items, even in remission periods. Patients with SLE remained 74.4% of the time in remission, 12.1% in LLDAS, 12.2% in intermediate activity, and 1.3% in flare (there were 64 flares in 36 patients). HCRU was significantly higher during flare periods compared with remission periods. Number of flares was independently associated with emergency department consultations, lab tests and X-ray performed, number of drugs prescribed, and hospitalizations. Conclusion Significantly more HCRU was observed in patients with SLE in flare compared to remission periods.
“…[6][7][8][9][10]31,32 Specially, patients with lupus nephritis contribute to a major economic burden comparing with lupus without nephritis. [11][12][13][14]33 Cumulative damage (highest SDI 34 scores) has also been described as a factor of increased disease costs, showing 10-year cumulative costs 9-fold higher than those with lower damage. 35 Data regarding economic burden of SLE are mainly from developed countries with scarce data from other countries.…”
Section: Discussionmentioning
confidence: 99%
“…32 Also in Colombia, annual costs for patients with lupus nephritis have been calculated to be 7.46 times greater than those without nephritis. 13 As far as we know, up to date there is no other data on SLE health care resource use from other Latin American countries and no data from Argentina. 46.4 (17.9) Follow-up time, years, median (IQR) 8.0 (5.0-12.4) Fulfilling 1997 ACR lupus criteria 23 , n (%) 46 (74.2) Fulfilling SLICC lupus criteria 24 , n (%) 62 (100) Charlson a score at diagnosis, median (IQR) 0 (0-2) Charlson a score at the end of follow-up, median (IQR) 1 (0-3) SLICC damage index score at the end of follow-up, median (IQR) 0 (0-2) Death, n (%) We found in our cohort that patients experienced the majority of the follow-up in a remission state (74.4% of the time), and the median time on remission was 62.5 months.…”
Section: Discussionmentioning
confidence: 99%
“…3 The economic burden of patients with SLE care has been addressed in some countries, 4,5 mainly estimating direct costs. Some studies have reported significant differences in costs generated by lupus patients with a severe disease [6][7][8][9][10] or with certain organ manifestations (renal/ neuropsychiatric) [11][12][13][14][15] in comparison with those with mild involvement.…”
Objective The aim is to analyze health care resource utilization (HCRU) of patients with lupus (SLE) from a health management organization (HMO) in Buenos Aires, Argentina, compared with matched controls and comparing periods of flare, low disease activity, and remission. Methods This is a retrospective observational study including all SLE incident cases (ACR 1997/SLICC 2012 criteria) between 2000 and 2020 and 5 matched controls. Clinical data and HCRU (medical and nonmedical consultations, lab and imaging tests performed, emergency room visits, hospitalizations, and drugs prescribed) were obtained from administrative databases and electronic medical records. For each patient with SLE, an activity state was determined in every month of follow-up: flare (BILAG A or 2 BILAG B); low disease activity (LLDAS); remission (DORIS definition); or intermediate activity (not fulfilling any of previous). Incidence rates for each HCRU item and incidence rate ratios between SLE and control patients were and between remission and flare periods were calculated. Multivariate negative binomial logistic regression analyses were performed for identification of variables associated with major resource use. Results A total of 62 SLE and 310 control patients were included, 88.7% were women, the median age at diagnosis was 46 years, and were followed for more than 8 years. Patients with SLE contributed with 537.2 patient-years (CI 95% 461.1–613.3) and controls with 2761.9 patient-years (CI 95% 2600.9–2922.8). HCRU in patients with SLE was significantly higher than in controls in all items, even in remission periods. Patients with SLE remained 74.4% of the time in remission, 12.1% in LLDAS, 12.2% in intermediate activity, and 1.3% in flare (there were 64 flares in 36 patients). HCRU was significantly higher during flare periods compared with remission periods. Number of flares was independently associated with emergency department consultations, lab tests and X-ray performed, number of drugs prescribed, and hospitalizations. Conclusion Significantly more HCRU was observed in patients with SLE in flare compared to remission periods.
“…The average annual per-patient, all-claims, all-cause direct cost for LN was 12,624 dollars, 7.5 times higher than the average lupus patient without LN. 27 Early diagnosis and proper treatment are important to control LN progression, especially preventing ESRD. 28 The reported improvements of LN outcomes have been attributed to earlier diagnosis and optimal management in European patients over the past decade.…”
Objective Lupus nephritis (LN) is the main complication of systemic lupus erythematosus (SLE), causing huge financial burden and poor quality of life. Due to the low compliance of renal biopsy, we aim to find a non-invasive biomarker of LN to optimize its predictive, preventive, and personalized medical service or management. Method Herein, we provided a bioinformatic screen combined clinical validation strategy for rapidly mining exosomal miRNAs for LN diagnosis and management. We screened out differentially expressed miRNAs (DEMs) and differentially expressed mRNAs (DEGs) in LN database and performed a miRNA-mRNA integrated analysis to select out reliable changed miRNAs in LN tissues by using R and Cytoscape. Urinary exosomes were collected by ultracentrifugation and analyzed by nano-tracking analysis and western blotting. Detection of aquaporin-2 showed the tubular source of urinary exosomes. Urinary exosomal miRNAs were detected by RT-qPCR and the target of miR-195-5p was verified by using bioinformatic, dual-luciferase, and western blotting. Result 15 miRNAs and their 60 target mRNAs were contained in miRNA-mRNA integrated map. Bioinformatic analysis showed these miRNAs were involved in various cellular biological process. Exosomal miR-195-5p, miR-25-3p, miR-429, and miR-218-5p were verified in a small clinical group (n = 47). Urinary exosomal miR-195-5p, miR-25-3p, and miR-429 were downregulated in patients and miR-195-5p could recognize LN patients from SLE with good sensitivity and specificity, showing good potential in LN disease monitoring and diagnosis. Conclusion We analyzed and obtained a series of differential miRNAs in LN kidney tissues and suggested that urinary exosomal miR-195-5p could serve as a novel biomarker in LN. Further, miR-195-5p-CXCL10 axis could be a therapeutic target of LN.
“…Similarly, southern sub-Saharan Africa (10.5%) and the group of Latin American countries aforementioned (7.7%) showed increasing trends in age-standardized point/prevalence estimates between 1990 and 2017. A Colombian study found that patients with SLE who developed lupus nephritis had a 7-fold increase in mean annual direct costs per patient for the health system in that country compared with patients without it [ 29 ]. The overall average annual direct cost per patient has been calculated around 2355 US dollars (USD) in Colombia, while for HICs, the mean annual direct costs per patient ranged from 2214 to 16 875 USD [ 30 ].…”
Section: Specific Challenges To Lmic Healthcare Systemsmentioning
SLE increases disease burden in those affected with it, and that is particularly the case in low- and middle-income countries. The 2019 Addressing Lupus Pillar of Health Advancement project is a multiphase initiative whose objective is to recognize, hierarchize and establish approaches for diligent SLE research, care and access to healthcare. Lack of access to high-cost medications that have been shown to be efficacious in the short term and that potentially reduce damage in SLE is a complex issue. In this review, we highlight opportunities and plans of action to diminish costs and improve access to therapies, which should be recognized and executed, preferably within regional strategies with multiple stakeholders (including supranational organizations, governments, the pharmaceutical industry, medical societies and the general population) connected with and grounded in structured and clear cost-effectiveness analysis.
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