Direct cost of lupus care in the developing world: the case of Colombia.

BACKGROUND: Lupus is a chronic autoimmune and incurable rheumatic disease and has a global prevalence of 3.2-517.5 cases per 100,000 people. However, currently there is no knowledge regarding the actual direct cost of patients with lupus to healthcare systems in developing countries. This study aimed to determine the direct cost of lupus care in Colombia. METHODS: To identify patients with lupus, claims data of 2 years from two health insurers were subjected to an algorithm according to International Statistical Classification of Diseases and Related Health Problems 10th Revision codes. Multivariate linear regression analyses were used to assess the direct cost of lupus care. RESULTS: The average annual per-patient, all-claims, all-cause direct cost was $2355; this is approximately 9 times the average annual premium received by health insurers for covering the public benefits package. Approximately 50% of direct costs are not included in the public benefits package. The incidence of one or more condition is 98.4%. The direct cost incurred by patients with two comorbidities was 1.8 times more, with three chronic conditions was 1.9 times more and with six chronic conditions was 4.5 times more than that incurred by patients with only lupus. CONCLUSIONS: The direct cost of lupus care in the developing world may be higher than expected; in addition, access to healthcare may not be equal for the entire population.

Socioeconomic status and organ damage in Mexican systemic lupus erythematosus women.

The objective of this cross-sectional study was to determine relationships between socioeconomic status and organ damage in Mexican systemic lupus erythematosus (SLE) patients. Demographic and clinical variables were assessed. Socioeconomic status was evaluated using the Graffar method and monthly household income. Lupus activity and organ damage were measured using the SLE disease activity scale, validated for the Mexican population (Mex-SLEDAI), and the Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) scale. The 143 Mexican female SLE patients included (mean age 40.1 ± 8.9 years, mean disease duration 8.9 ± 6.3 years) had a mean monthly household income of $ 407.2 ± 326.5. According to the Graffar index, 18.9%, 52.5%, and 28.7% had high/medium-high, medium, and medium-low/low socioeconomic status, respectively. Organ damage was observed in 61 patients (42.7%). Patients with organ damage had lower monthly household incomes ($241.4 ± 152.4 vs. $354.8 ± 288.3) and were more frequently unemployed (57.3% vs. 35.3%; p = 0.01) than those without. Low monthly income was not associated with lupus activity or self-reported health status. In the adjusted multivariate analysis, low monthly income ( < $300) was associated with organ damage. In conclusion, low income may be associated with organ damage in Mexican SLE patients.

Healthcare utilization and comorbidity burden among children and young adults in the United States with systemic lupus erythematosus or inflammatory bowel disease.

OBJECTIVE: We sought to assess the feasibility of using a health insurance claims database to estimate the prevalence and health care utilization and costs among children diagnosed with systemic lupus erythematosus (SLE) and inflammatory bowel disease (IBD). STUDY DESIGN: This was a retrospective analysis of the LifeLink insurance claims database for the years 2000-2006. Children (0-15 years) and young adults (16-25 years) with ≥ 2 diagnosis claims for SLE or IBD were selected as the 2 cohorts of interest. For each member of the SLE and IBD cohorts, 2 individuals were randomly selected for a matched comparison group. All the analyses were descriptive in nature, CI for differences between means and 2 proportions for measures including health care utilization, comorbidity burden were based on t tests and 2-group tests of proportions. RESULTS: We identified 278 patients with SLE (prevalence estimate: 7.9 per/100000 population) and 1174 patients with IBD (33.2 per/100000 population). The mean annual total medical costs was substantially higher for the SLE (difference: $22223; 95% CI: $14961-$29485) and IBD (difference: $16238; 95% CI: $14395-$18082) cohorts compared with those of the comparator cohort. We observed higher comorbidity burdens in the SLE and IBD cohorts than we saw in the comparator cohort. CONCLUSIONS: Administrative claims data can be a useful tool for assessing the comparative prevalence and associated resource utilization of rare conditions such as SLE and IBD.

Cost of medication errors in rheumatic patients in Mexico.

This study aims to measure the frequency of medication error (ME) in rheumatology outpatients of the Social Security System (SS) in Mexico and to measure the costs by comparing the days lost at work as direct consequence of the medication error against the theoretical cost of no error in the process. A prospective 6-month survey was conducted in a reference hospital in Guadalajara, Mexico. ME was defined as any discrepancy between the prescription and medicine taken by patients. The origin of the discrepancy was identified and registered. We present 381 patients: 292 with rheumatoid arthritis, 57 with ankylosing spondylitis, and 32 with systemic lupus erythematosus. One hundred twenty seven (33%) had medication errors. Ninety eight (77%) got worse in their condition due to ME. Forty percent of MEs were due to patients' decisions, 41% to a lack of availability of medication which should have been provided by SS, and 18% to a non-justified medical decision by primary-care providers. Patients lost in average 3 working days each month because of the ME. The cost of ME is high. In the case analyzed, opportune access to treatment represents a lower cost for the system, but it represents a significant loss of days at work each month. ME is a signal of a system failure. Inter-professional teamwork is needed to perfect the system.

Patrón de expresión clínica y epidemiológica de un grupo de pacientes con lupus eritematoso sistémico en dos centros especializados en reumatología, AGAR y una clínica privada / Pattern clinical and epidemilogic espresion in a group of patients with systemic lupus erytematosus in two reumatology centers specialized AGAR and in a private clinic

El LES (Lupus Eritematoso Sistémico) representa un síndrome clínico, más que una entidad patológica única con diversidad de presentaciones clìnicas que varían en las diferentes poblaciones del mundo. En Guatemala actualmente existen pocos estudios publicados. Nuestro objetivo: evaluar aspectos socioeconómicos, demográficos, raciales, evolución clínica y comportamiento de la enfermedad, en grupo de pacientes con LES, entre julio 1997 y diciembre 2003. En base a estudio descriptivo de 47 pacientes que consultaron en clínicas AGAR y una clínica privada AGK. Resultados: Mayor incidencia en cuarta década; 100/100 sexo femenino; la deserción es alta 21 (44.6/100) en ambos centros, mayor en clínica privada, creemos que es por factores económicos