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Rheumatology Advance Access published online on January 30, 2008
Rheumatology, doi:10.1093/rheumatology/kem373
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© 2008 The Author(s)
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/2.0/uk/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

SLE patients with renal damage incur higher health care costs

A. E. Clarke1,2, P. Panopalis3, M. Petri4, S. Manzi5,6, D. A. Isenberg7, C. Gordon8, J.-L. Senécal9, L. Joseph2,10, Y. St Pierre2 and T. Li11

1Department of Medicine, Division of Clinical Immunology/Allergy, 2Department of Medicine, Division of Clinical Epidemiology, McGill University Health Centre, McGill University, Montréal, Québec, 3Department of Medicine, Division of Rheumatology, University of California, San Francisco, CA, 4Johns Hopkins University School of Medicine, Baltimore, MD, 5Department of Medicine, Division of Rheumatology, and 6Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA, 7Centre for Rheumatology, Department of Medicine, University College London, London, 8Department of Rheumatology, Division of Immunity and Infection, University of Birmingham, Birmingham, UK, 9Department of Medicine, Division of Rheumatology, Centre Hospitalier de L’Université de Montréal, Université de Montréal, 10Department of Epidemiology and Biostatistics, McGill University, Montréal, Québec and 11Global Epidemiology and Outcomes Research, Bristol-Myers Squibb Company, Princeton, NJ, USA.

Correspondence to: A. Clarke, McGill University Health Centre (MUHC), 687 Pine Avenue West, V Building, Montreal, Quebec, Canada H3A 1A1. E-mail: ann.clarke{at}mcgill.ca


  Abstract

Objectives.: To compare costs and quality of life (QoL) between SLE patients with and without renal damage.

Methods.: Seven hundred and fifteen patients were surveyed semi-annually over 4 yrs on health care use and productivity loss and annually on QoL. Cumulative direct and indirect costs (2006 Canadian dollars) and QoL (average annual change in SF-36) were compared between patients with and without renal damage [Systemic Lupus International Collaborating Clinics/ACR Damage Index (SLICC/ACR DI)] using simultaneous regressions.

Results.: At study conclusion, for patients with the renal subscale of the SLICC/ACR DI = 0 (n = 634), 1 (n = 54), 2 (n = 15) and 3 (n = 12), mean 4-yr cumulative direct costs per patient (95% CI) were $20 337 ($18 815, $21 858), $27 869 ($19 230, $36 509), $51 191 ($23 463, $78 919) and $99 544 ($57 102, $141 987), respectively. In a regression where the renal subscale of the SLICC/ACR DI was a single indicator variable, on average (95% CI), each unit increase in renal damage was associated with a 24% (15%, 33%) increase in direct costs. In a regression where each level in the renal subscale was an indicator variable, patients with end-stage renal disease incurred 103% (65%, 141%) higher direct costs than those without renal damage. Cumulative indirect costs and annual change in the SF-36 summary scores did not differ between patients.

Conclusions.: SLE patients with renal damage incurred higher direct costs, but did not experience a poorer QoL. QoL may be more influenced by concurrent renal activity than accumulated renal damage, which can occur at any time and patients may gradually habituate to their compromised health state.

KEY WORDS: SLE, Direct costs, Indirect costs, Quality of life, Renal damage

Submitted 28 August 2007; revised version accepted 17 December 2007.
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