title: Clinical and financial burden of active lupus in Greece: a nationwide study.
abstract: Analyses of the medical and economic burden of chronic disorders such as systemic lupus erythematosus (SLE) are valuable for clinical and health policy decisions. We performed a chart-based review of 215 adult SLE patients with active autoantibody-positive disease at the predefined ratio of 30% severe (involvement of major organs requiring treatment) and 70% non-severe, followed at seven hospital centres in Greece. We reviewed 318 patients consecutively registered over three months (sub-study). Disease activity, organ damage, flares and healthcare resource utilization were recorded. Costs were assessed from the third-party payer perspective. Severe SLE patients had chronic active disease more frequently (22.4% vs 4.7%), higher average SLE disease activity index (SLEDAI) (10.5 vs 6.1) and systemic lupus international collaborating clinics (SLICC) damage index (1.1 vs 0.6) than non-severe patients. The mean annual direct medical cost was €3741 for severe vs €1225 for non-severe patients. Severe flares, active renal disease and organ damage were independent cost predictors. In the sub-study, 19% of unselected patients were classified as severe SLE, and 30% of them had chronic active disease. In conclusion, this is the first study to demonstrate the significant clinical and financial burden of Greek SLE patients with active major organ disease. Among them, 30% display chronic activity, in spite of standard care, which represents a significant unmet medical need.
authors.affiliation: Rheumatology, Clinical Immunology and Allergy, University of Crete School of Medicine, Heraklion, Greece.
authors.forename: G
authors.initials: G
authors.lastname: Bertsias
authors.affiliation: Department of Health Economics, National School of Public Health, Athens, Greece.
authors.forename: E
authors.initials: E
authors.lastname: Karampli
authors.affiliation: Rheumatology, Clinical Immunology and Allergy, University of Crete School of Medicine, Heraklion, Greece.
authors.forename: P
authors.initials: P
authors.lastname: Sidiropoulos
authors.affiliation: Rheumatology, Clinical Immunology and Allergy, University of Crete School of Medicine, Heraklion, Greece.
authors.forename: I
authors.initials: I
authors.lastname: Gergianaki
authors.affiliation: Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Drosos
authors.affiliation: Department of Medicine/Rheumatology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
authors.forename: L
authors.initials: L
authors.lastname: Sakkas
authors.affiliation: Fourth Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Garyfallos
authors.affiliation: Department of Pathophysiology, University of Athens Medical School, Athens, Greece Joint Rheumatology Programme, Faculty of Medicine, University of Athens Medical School, Athens, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Tzioufas
authors.affiliation: Second Department of Medicine, Hippokration General Hospital, University of Athens Medical School, Athens, Greece Joint Rheumatology Programme, Faculty of Medicine, University of Athens Medical School, Athens, Greece.
authors.forename: D
authors.initials: D
authors.lastname: Vassilopoulos
authors.affiliation: Second Department of Medicine, Hippokration General Hospital, University of Athens Medical School, Athens, Greece.
authors.forename: C
authors.initials: C
authors.lastname: Tsalapaki
authors.affiliation: Joint Rheumatology Programme, Faculty of Medicine, University of Athens Medical School, Athens, Greece First Department of Propaedeutic/Internal Medicine, University of Athens Medical School, Laiko General Hospital, Athens, Greece.
authors.forename: P
authors.initials: P
authors.lastname: Sfikakis
authors.affiliation: First Department of Propaedeutic/Internal Medicine, University of Athens Medical School, Laiko General Hospital, Athens, Greece.
authors.forename: S
authors.initials: S
authors.lastname: Panopoulos
authors.affiliation: Department of Health Economics, National School of Public Health, Athens, Greece.
authors.forename: K
authors.initials: K
authors.lastname: Athanasakis
authors.affiliation: Global Specialty Pharma Franchise, GlaxoSmithKline, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Perna
authors.affiliation: GlaxoSmithKline, Athens, Greece.
authors.forename: D
authors.initials: D
authors.lastname: Psomali
authors.affiliation: Department of Health Economics, National School of Public Health, Athens, Greece.
authors.forename: J
authors.initials: J
authors.lastname: Kyriopoulos
authors.affiliation: Joint Rheumatology Programme, Faculty of Medicine, University of Athens Medical School, Athens, Greece Fourth Department of Medicine, Attikon University Hospital, University of Athens Medical School, Athens, Greece boumpasd@med.uoc.gr.
authors.forename: D
authors.initials: D
authors.lastname: Boumpas
mesh_terms: D000328:Adult; D001323:Autoantibodies / Q000276:immunology; D005260:Female; D006115:Greece; D017048:Health Care Costs; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy* / Q000191:economics* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index
chemical_list: D001323:Autoantibodies
keywords: Lupus nephritis; biologics; disease activity; hospitalization; laboratory tests; organ damage