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Digital ulcers in systemic sclerosis: their epidemiology, clinical characteristics, and associated clinical and economic burden

BACKGROUND: To determine the frequency and clinical characteristics of systemic sclerosis-related digital ulcers, and associated direct health care costs, quality of life, and survival. METHODS: Digital ulcers (DUs) were defined as an area with a visually discernible depth and a loss of continuity o...

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Autores principales: Morrisroe, Kathleen, Stevens, Wendy, Sahhar, Joanne, Ngian, Gene-Siew, Ferdowsi, Nava, Hill, Catherine L., Roddy, Janet, Walker, Jennifer, Proudman, Susanna, Nikpour, Mandana
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6929369/
https://www.ncbi.nlm.nih.gov/pubmed/31870459
http://dx.doi.org/10.1186/s13075-019-2080-y
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author Morrisroe, Kathleen
Stevens, Wendy
Sahhar, Joanne
Ngian, Gene-Siew
Ferdowsi, Nava
Hill, Catherine L.
Roddy, Janet
Walker, Jennifer
Proudman, Susanna
Nikpour, Mandana
author_facet Morrisroe, Kathleen
Stevens, Wendy
Sahhar, Joanne
Ngian, Gene-Siew
Ferdowsi, Nava
Hill, Catherine L.
Roddy, Janet
Walker, Jennifer
Proudman, Susanna
Nikpour, Mandana
author_sort Morrisroe, Kathleen
collection PubMed
description BACKGROUND: To determine the frequency and clinical characteristics of systemic sclerosis-related digital ulcers, and associated direct health care costs, quality of life, and survival. METHODS: Digital ulcers (DUs) were defined as an area with a visually discernible depth and a loss of continuity of epithelial coverage. DU severity was calculated based on the physician reported highest number of new DUs at clinical review (mild = 1–5 DUs, moderate 6–10 DUs, severe > 10 DUs). Healthcare use was captured through data linkage, wherein SSc clinical data captured prospectively in a dedicated clinical database were linked with health services databases to capture hospital admissions, emergency department (ED) presentations and ambulatory care (MBS) utilization and cost for the period 2008–2015. Healthcare cost determinants were estimated using logistic regression. RESULTS: Among 1085 SSc patients, 48.6% experienced a DU over a mean follow-up of 5.2 ± 2.5 years. Those who developed DUs were more likely to have diffuse disease subtype (34.9% vs 18.2%, p < 0.001), anti-Scl-70 antibody (18.9% vs 9.3%, p < 0.001), and a younger age at SSc onset (43.6 ± 13.9 vs 48.8 ± 14.0 years, p < 0.001) in addition to reduced health-related quality of life (HRQoL) measured by the SF-36 but without a significant impact on survival. SSc patients with a history of a DU utilized significantly more healthcare resources per annum than those without a DU, including hospitalizations, ED presentation, and ambulatory care services. Total healthcare services, excluding medications, were associated with an annual excess cost per DU patient of AUD$12,474 (8574-25,677), p < 0.001, driven by hospital admission and ED presentation costs. CONCLUSION: DUs place a large burden on the patient and healthcare system through reduced HRQoL and increased healthcare resource utilization and associated cost.
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spelling pubmed-69293692019-12-30 Digital ulcers in systemic sclerosis: their epidemiology, clinical characteristics, and associated clinical and economic burden Morrisroe, Kathleen Stevens, Wendy Sahhar, Joanne Ngian, Gene-Siew Ferdowsi, Nava Hill, Catherine L. Roddy, Janet Walker, Jennifer Proudman, Susanna Nikpour, Mandana Arthritis Res Ther Research Article BACKGROUND: To determine the frequency and clinical characteristics of systemic sclerosis-related digital ulcers, and associated direct health care costs, quality of life, and survival. METHODS: Digital ulcers (DUs) were defined as an area with a visually discernible depth and a loss of continuity of epithelial coverage. DU severity was calculated based on the physician reported highest number of new DUs at clinical review (mild = 1–5 DUs, moderate 6–10 DUs, severe > 10 DUs). Healthcare use was captured through data linkage, wherein SSc clinical data captured prospectively in a dedicated clinical database were linked with health services databases to capture hospital admissions, emergency department (ED) presentations and ambulatory care (MBS) utilization and cost for the period 2008–2015. Healthcare cost determinants were estimated using logistic regression. RESULTS: Among 1085 SSc patients, 48.6% experienced a DU over a mean follow-up of 5.2 ± 2.5 years. Those who developed DUs were more likely to have diffuse disease subtype (34.9% vs 18.2%, p < 0.001), anti-Scl-70 antibody (18.9% vs 9.3%, p < 0.001), and a younger age at SSc onset (43.6 ± 13.9 vs 48.8 ± 14.0 years, p < 0.001) in addition to reduced health-related quality of life (HRQoL) measured by the SF-36 but without a significant impact on survival. SSc patients with a history of a DU utilized significantly more healthcare resources per annum than those without a DU, including hospitalizations, ED presentation, and ambulatory care services. Total healthcare services, excluding medications, were associated with an annual excess cost per DU patient of AUD$12,474 (8574-25,677), p < 0.001, driven by hospital admission and ED presentation costs. CONCLUSION: DUs place a large burden on the patient and healthcare system through reduced HRQoL and increased healthcare resource utilization and associated cost. BioMed Central 2019-12-23 2019 /pmc/articles/PMC6929369/ /pubmed/31870459 http://dx.doi.org/10.1186/s13075-019-2080-y Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Morrisroe, Kathleen
Stevens, Wendy
Sahhar, Joanne
Ngian, Gene-Siew
Ferdowsi, Nava
Hill, Catherine L.
Roddy, Janet
Walker, Jennifer
Proudman, Susanna
Nikpour, Mandana
Digital ulcers in systemic sclerosis: their epidemiology, clinical characteristics, and associated clinical and economic burden
title Digital ulcers in systemic sclerosis: their epidemiology, clinical characteristics, and associated clinical and economic burden
title_full Digital ulcers in systemic sclerosis: their epidemiology, clinical characteristics, and associated clinical and economic burden
title_fullStr Digital ulcers in systemic sclerosis: their epidemiology, clinical characteristics, and associated clinical and economic burden
title_full_unstemmed Digital ulcers in systemic sclerosis: their epidemiology, clinical characteristics, and associated clinical and economic burden
title_short Digital ulcers in systemic sclerosis: their epidemiology, clinical characteristics, and associated clinical and economic burden
title_sort digital ulcers in systemic sclerosis: their epidemiology, clinical characteristics, and associated clinical and economic burden
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6929369/
https://www.ncbi.nlm.nih.gov/pubmed/31870459
http://dx.doi.org/10.1186/s13075-019-2080-y
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