El costo de la atención ambulatoria del lupus eritematoso sistémico en Colombia. Contrastes y comparaciones con otras poblaciones.

Abstract

Background: Systemic lupus erythematosus (SLE) is considered a high cost disease. The clinical expression of the disease varies depending upon geography and ethnicity. The aim of this study was to calculate ambulatory cost related to SLE in a Colombian cohort, to identify cost predictors and to compare our results with those of other populations. Methods: A prevalence-based approach was done in 100 SLE patients in whom information related to direct medical, direct non-medical, indirect, and intangible costs was assessed. All medical costs were evaluated using a bottom-up methodology. The direct medical costs were assessed from a society perspective using a micro-costing method. Indirect costs were estimated using human capital approach, and intangible costs were calculated from Quality-Adjusted Life Years (QALY). Multivariate analysis were used to analyse data. For comparisons with other populations, all costs were expressed as the ratio between the costs and the country gross domestic product (GDP) per capita. Results: The mean of total ambulatory costs was 13,031 ± 9,215 USD (adjusted by the World Bank purchasing power parity conversion factor), which is 1.66 times Colombia’s GDP per capita. Direct costs explained 64% of total costs. Medical costs accounted for 80% of direct costs. Indirect costs constituted 10% of total costs, and intangible costs were 25% of total costs. Medications represented 45% of direct costs. Higher total costs were associated with socioeconomic status, private insurance, QALY, alopecia, mycophenolate mofetil use, and anticoagulation therapy. Total adjusted direct costs of SLE in Colombia were higher than in North America and Europe. Conclusion: SLE imposes a substantial economic burden on Colombian society. The costs associated with medical care and QALY were major contributors to the high cost-of-illness. These results may assist in defining public health policies as well as in comparing health expenditure internationally.