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  • Alexander, G Caleb  (2)
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  • 1
    In: Lupus, SAGE Publications, Vol. 31, No. 7 ( 2022-06), p. 773-807
    Abstract: To evaluate health care utilization and costs for patients with systemic lupus erythematosus (SLE) by disease severity. Methods We searched PubMed and Embase from January 2000 to June 2020 for observational studies examining health care utilization and costs associated with SLE among adults in the United States. Two independent reviewers reviewed the selected full-text articles to determine the final set of included studies. Costs were converted to 2020 US $. Results We screened 9224 articles, of which 51 were included. Mean emergency department visits were 0.3–3.5 per year, and mean hospitalizations were 0.1–2.4 per year (mean length of stay 0.4–13.0 days). Patients averaged 10–26 physician visits/year. Mean annual direct total costs were $17,258–$63,022 per patient and were greater for patients with moderate or severe disease ($19,099–$82,391) compared with mild disease ($12,242–$29,233). Mean annual direct costs were larger from commercial claims ($24,585–$63,022) than public payers (Medicare and Medicaid: $18,302–$27,142). Conclusions SLE remains a significant driver of health care utilization and costs. Patients with moderate to severe SLE use more health care services and incur greater direct and indirect costs than those with mild disease.
    Type of Medium: Online Resource
    ISSN: 0961-2033 , 1477-0962
    RVK:
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2022
    detail.hit.zdb_id: 2008035-9
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  • 2
    In: BMJ Open, BMJ, Vol. 10, No. 5 ( 2020-05), p. e031850-
    Abstract: At least half of patients with systemic lupus erythematosus (SLE) develop organ damage as a consequence of autoimmune disease or long-term therapeutic steroid use. This study synthesised evidence on the association between organ damage and mortality in patients with SLE. Design Systematic review and meta-analysis. Methods Electronic searches were performed in PubMed, Embase, Cochrane Library and Latin American and Caribbean Health Sciences Literature for observational (cohort, case-control and cross-sectional) studies published between January 2000 and February 2017. Included studies reported HRs or ORs on the association between organ damage (measured by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) score) and mortality. Study quality was assessed using the modified Newcastle-Ottawa assessment. Pooled HRs were obtained using the DerSimonian and Laird random-effects model. Heterogeneity was assessed using the Cochrane Q (Q) and I 2 statistics. Results The search yielded 10 420 articles, from which 21 longitudinal studies were selected. Most studies (85%) were of high quality. For 10 studies evaluating organ damage (SDI) as a continuous variable and reporting HR as a measure of association, a 1-unit increase in SDI was associated with increased mortality; pooled HR was 1.34 (95% CI: 1.24 to 1.44, p 〈 0.001; Q p=0.027, I 2 =52.1%). Exclusion of one potential outlying study reduced heterogeneity with minimal impact on pooled HR (1.33 (95% CI: 1.25 to 1.42), p 〈 0.001, Q p=0.087, I 2 =42.0%). The 11 remaining studies, although they could not be aggregated because of their varying patient populations and analyses, consistently demonstrated that greater SDI was associated with increased mortality. Conclusions Organ damage in SLE is consistently associated with increased mortality across studies from various countries. Modifying the disease course with effective therapies and steroid-sparing regimens may reduce organ damage, improve outcomes and decrease mortality for patients with SLE.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    Language: English
    Publisher: BMJ
    Publication Date: 2020
    detail.hit.zdb_id: 2599832-8
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