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Rheumatology (Oxford). 2019 Nov 18. pii: kez532. doi: 10.1093/rheumatology/kez532. [Epub ahead of print]

The clinical and economic burden of systemic sclerosis related interstitial lung disease.

Author information

1
Department of Medicine, The University of Melbourne at St Vincent's Hospital.
2
Department of Rheumatology, St Vincent's Hospital.
3
Department of Medicine, Monash University, Clayton and Monash Health, Melbourne, Victoria.
4
Rheumatology Unit, Royal Adelaide Hospital, North Terrace.
5
Rheumatology Unit, The Queen Elizabeth Hospital.
6
Discipline of Medicine, University of Adelaide, Adelaide, South Australia.
7
Department of Rheumatology, Royal Perth Hospital, Perth, Western Australia.
8
Rheumatology Unit, Flinders Medical Centre, Adelaide, South Australia, Australia.

Abstract

OBJECTIVE:

To quantify the burden of interstitial lung disease (ILD) in SSc.

METHODS:

Clinical data for SSc patients enrolled in the Australian Scleroderma Cohort Study were linked with healthcare databases for the period 2008-2015. ILD was defined by characteristic fibrotic changes on high-resolution CT (HRCT) lung, while severity was defined by the extent lung involvement on HRCT (mild <10%, moderate 10-30%, severe >30%). Determinants of healthcare cost were estimated using logistic regression.

RESULTS:

SSc-ILD patients utilized more healthcare resources, including hospitalization, emergency department presentation and ambulatory care services, than those without ILD with a total cost per patient of AUD$48 368 (26 230-93 615) vs AUD$33 657 (15 144-66 905), P<0.001) between 2008-2015. Healthcare utilization was associated with an annual median (25th-75th) excess cost per SSc-ILD patient compared with those without ILD of AUD$1192 (807-1212), P<0.001. Increasing ILD severity was associated with significantly more healthcare utilization and costs with an annual excess cost per patient with severe ILD compared with mild ILD of AUD$2321 (645-1846), P<0.001. ILD severity and the presence of coexistent PAH were the main determinants of overall healthcare cost above median for this SSc-ILD cohort (OR 5.1, P<0.001, and OR 2.6, P=0.01, respectively). Furthermore, SSc-ILD patients reported worse physical HRQoL compared with those without ILD [34.3 (10.5) vs 39.1 (10.8), P<0.001], with a progressive decline with increasing ILD severity (P=0.002).

CONCLUSION:

SSc-ILD places a large burden on the healthcare system and the patient through poor HRQoL in addition to incremental healthcare resource utilization and associated direct cost.

KEYWORDS:

Systemic sclerosis; economic burden; health-related quality of life; healthcare utilization; interstitial lung disease; scleroderma

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