Incremental health care services and expenditures associated with depression among individuals with cutaneous lupus erythematosus (CLE)

Abstract

Objectives The objective of this paper is to describe the annual direct medical expenditures for cutaneous lupus erythematosus (CLE) patients, and to estimate the incremental health care expenditures and utilization associated with depression among adults with CLE, while controlling for covariates. Methods Using the 2014 Medical Expenditure Panel Survey (MEPS), we compared CLE patients with and without depression to determine differences in: (a) health care utilization-inpatient, outpatient, office-based and emergency room (ER) visits, and prescriptions filled; and (b) expenditures-total costs, inpatient, outpatient, office-based, ER, and prescription medication costs, and other costs using demography-adjusted and comorbidity-adjusted multivariate models (age, gender, race/ethnicity, marital status, education, perception of health status, poverty category, smoking status, and Charlson Comorbidity Index). Results The total direct medical expenditure associated with CLE is estimated at approximately $29.7 billion in 2014 US dollars. After adjusting for covariates, adults with CLE and depression had more hospital discharges (utilization ratio (UR) = 1.13, 95% confidence interval (CI) (1.00-1.28)), ER visits (UR = 1.17, 95% CI (1.09-1.37)), and prescribed medicines (UR = 2.15, 95% CI (1.51-3.05)) than those without depression. Adults with CLE and depression had significantly higher average annual total expenditure that those without depression ($19,854 vs. $9735). Conclusions High health care expenditures are significant for patients with CLE, especially among those with depression. Prescription drugs, inpatient visits, and ER visits contributed most to the total expenditures in CLE patients with depression. Early diagnosis and treatment of depression in CLE patients may reduce total health care expenditures and utilization in this population.

Public Health Expenditure and Under-five Mortality in Nigeria: An Overview for Policy Intervention

“…Nevertheless, researchers have been able to give reasons to some of the shortcomings present in the health-care sector in Nigeria. For instance, Ogunsanya et al (2018) [18] blamed Nigeria poor health performance to the fluctuating government revenue gotten from oil price. For instance, considering the country's budgetary allocation for health, the Federal Ministry of Health appropriation bill is 340.456 billion naira out of the total budget of 8.612 trillion naira in 2018 representing 3.95% of the total budget.…”

Factors associated with quality of life in cutaneous lupus erythematosus using the Revised Wilson and Cleary Model

“…40 While depression has not been extensively studied in cross-sectional studies conducted in CLE patients, a qualitative study reported that self-reported depression was a concern for patients. 18 A plausible reason for the insignificance in the current study, despite the prevalence of depression in CLE 39,47 , is that depression is commonly underdiagnosed in other chronic diseases, 48 and is likely applicable to CLE. Current and past smoking histories have been linked to an increase in systemic vascular inflammatory processes such as IL-6, 49 which can worsen some symptoms and, subsequently, QoL.…”

Differences in quality of life in patients with cutaneous lupus erythematosus with varying income levels

“…The estimated average annual incremental cost for CLE was 10,119 USD in 2018. 17 The difficulties of being low income compounded with the financial, emotional and physical toll of having CLE likely result in poorer quality of life among low income patients with CLE.…”