Abstract：
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.
CONCLUSIONS: Significantly more HCRU was observed in patients with SLE in flare compared to remission periods.
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.
CONCLUSIONS: Significantly more HCRU was observed in patients with SLE in flare compared to remission periods.
摘要：
目的：目的是分析布宜诺斯艾利斯健康管理组织（HMO）的狼疮（SLE）患者的医疗资源利用（HCRU），阿根廷,与匹配的对照相比，并比较耀斑的时期，低疾病活动，和缓解。
方法：这是一项回顾性观察性研究，包括2000年至2020年之间的所有SLE事件病例（ACR1997/SLICC2012标准）和5个匹配的对照。临床数据和HCRU(医疗和非医疗咨询，实验室和成像测试，急诊室探视,住院治疗,和处方药物）是从行政数据库和电子病历中获得的。对于每个SLE患者，在每个月的随访中确定了一个活动状态:耀斑(BILAGA或2BILAGB);低疾病活动度(LLDAS);缓解(DORIS定义);或中间活动(不满足以前的任何一项).计算每个HCRU项目的发生率以及SLE与对照组患者之间以及缓解期和发作期之间的发生率比率。进行了多变量负二项逻辑回归分析，以识别与主要资源使用相关的变量。
结果：共纳入62例SLE和310例对照患者，88.7%是女性，诊断时的中位年龄为46岁，并被跟踪超过8年。SLE患者占537.2患者年（CI95％461.1-613.3），对照组占2761.9患者年（CI95％2600.9-2922.8）。在所有项目中，SLE患者的HCRU均明显高于对照组，即使在缓解期。SLE患者仍有74.4%的时间处于缓解期,12.1%在LLDAS，中间活性12.2%，耀斑占1.3%(36例患者中有64次耀斑)。与缓解期相比，HCRU在发作期明显更高。耀斑的数量与急诊科会诊独立相关，实验室测试和X射线检查，处方的药物数量，和住院。
结论：与缓解期相比，在SLE患者中观察到的HCRU明显更多。
方法：这是一项回顾性观察性研究，包括2000年至2020年之间的所有SLE事件病例（ACR1997/SLICC2012标准）和5个匹配的对照。临床数据和HCRU(医疗和非医疗咨询，实验室和成像测试，急诊室探视,住院治疗,和处方药物）是从行政数据库和电子病历中获得的。对于每个SLE患者，在每个月的随访中确定了一个活动状态:耀斑(BILAGA或2BILAGB);低疾病活动度(LLDAS);缓解(DORIS定义);或中间活动(不满足以前的任何一项).计算每个HCRU项目的发生率以及SLE与对照组患者之间以及缓解期和发作期之间的发生率比率。进行了多变量负二项逻辑回归分析，以识别与主要资源使用相关的变量。
结果：共纳入62例SLE和310例对照患者，88.7%是女性，诊断时的中位年龄为46岁，并被跟踪超过8年。SLE患者占537.2患者年（CI95％461.1-613.3），对照组占2761.9患者年（CI95％2600.9-2922.8）。在所有项目中，SLE患者的HCRU均明显高于对照组，即使在缓解期。SLE患者仍有74.4%的时间处于缓解期,12.1%在LLDAS，中间活性12.2%，耀斑占1.3%(36例患者中有64次耀斑)。与缓解期相比，HCRU在发作期明显更高。耀斑的数量与急诊科会诊独立相关，实验室测试和X射线检查，处方的药物数量，和住院。
结论：与缓解期相比，在SLE患者中观察到的HCRU明显更多。
