The impact of flare on disease costs of patients with systemic lupus erythematosus.

OBJECTIVE: To evaluate both direct and indirect costs of systemic lupus erythematosus (SLE) patients with and without flares from a societal perspective, and to investigate the impact of the severity and clinical manifestations of flares on direct/indirect costs. METHODS: A retrospective cost-of-illness study was performed on 306 SLE patients. Participants completed questionnaires on sociodemographics, employment status, and out-of-pocket expenses. Health resources consumption was recorded by chart review and patient self-reported questionnaire. The total number of flares and involved organs during the preceding 12 months were recorded. Multiple linear regression was performed to determine the cost predictors. RESULTS: Patients with flares were younger, had shorter disease duration, and had higher disease activity at the time of the assessment. The overall incidence of lupus flares was 0.24 episodes per patient-year. Patients with flares used more health care resources and incurred significantly higher annual direct and indirect costs. The mean total costs per patient-year were 2-fold higher for patients with flares ($22,580 versus $10,870 [2006 US dollars]; P < 0.0005). Multiple regression analysis showed that the number of flares was an independent explanatory variable associated with increased direct costs. Patients with multiorgan flares or renal/neuropsychiatric flares incurred higher direct costs compared with those with single-organ flares or with other organ flares. CONCLUSION: Patients with flares incur higher direct and indirect costs compared with those without flares. Major organ flares incur higher disease costs than other organ flares. Treatments that effectively control disease activity and prevent flares, especially major organ flares, may reduce the high costs associated with flare in SLE.

Clinical outcome of hypertension management.

OBJECTIVE: This study aimed to investigate the association between inadequately controlled hypertension, medication use pattern and the incidence of cardiovascular events (CVEs) over 5 years. The cost of hospitalisation associated with inadequately controlled hypertension was estimated. METHODS: This was a retrospective observational study of patients who were diagnosed with hypertension with at least one blood pressure reading recorded at baseline (year 2000), reviewed from 2001-2005. Primary endpoints were the extent, duration and prevalence of blood pressure deviation from treatment goals. Secondary endpoints were incidence of CVEs and the number of days of hospitalisation associated with inadequately controlled hypertension. RESULTS: In total, the medical records of 210 patients were reviewed. Statistically significant positive associations were found between inadequately controlled systolic blood pressure with the incidence of CVEs (p=0.018) and increased cardiovascular drugs (p<0.001), non-cardiovascular drugs (p=0.019) and total drug usage (p<0.001). Similar observations were observed between inadequately controlled diastolic blood pressure and increased cardiovascular (p<0.05) and total (p=0.007) drug usage. Patients with uncontrolled blood pressure at all times during the study period were associated with a higher incidence of CVEs (p=0.026). The mean cost of hospitalisation due to CVEs was estimated to be HK$42,584.0 +/- 36,670.0 (US$1 = HK$7.8) and it accounted for 3.3% of the total healthcare expenditure during 2005. CONCLUSION: Inadequately controlled blood pressure is positively associated with an increased incidence of CVEs and polypharmacy in Hong Kong Chinese hypertensive patients.