January 16, 2020
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SSc-related digital ulcers linked to worse disease burden, worse QoL, excess costs

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Patients with digital ulcers related to systemic sclerosis experience worse disease burden, worse quality of life and an excess annual cost of AUD $12,474 per patient driven largely by hospital and ED admissions, according to findings published in Arthritis Research & Therapy.

“Digital ulcers (DUs) are a common and debilitating ischemic manifestation in SSc, representing end-organ damage from progressive vasculopathy and serving as a biomarker of disease severity and internal organ involvement,” Kathleen Morrisroe, MBBS, FRACP, PhD, of the University of Melbourne at St. Vincent’s Hospital, Australia, and colleagues wrote. “The presence of DU at any time is associated with DU recurrence, gastrointestinal involvement, and increased SSc-related mortality.”

They added, “Despite more than 50% to 70% of SSc patients reporting a history of DUs and 10% reporting a new DU within the prior 12months, there is scant literature quantifying the burden of DUs in terms of health care utilization and associated economic cost.”

To analyze the frequency and clinical characteristics of digital ulcers related to SSc, as well their impact on patients’ health care costs, quality of life and survival, Morrisroe and colleagues studied data from the Australian Scleroderma Cohort Study, which collects demographic and disease-related data annually. For their study, the researchers examined data from 1,085 adult patients with SSc recruited between January 2008 and December 2015.

Patients with digital ulcers related to systemic sclerosis experience worse disease burden, worse quality of life and an excess annual cost of AUD $12,474 per patient driven largely by hospital and ED admissions, according to findings.

The researchers defined digital ulcers as an area with a visually discernible depth and a loss of continuity of epithelial coverage. In addition, severity was determined based on the physician-reported highest number of new digital ulcers at clinical review, with milddefined as 1 to 5 ulcers, moderate as 6 to 10 and severe as more than 10. The researchers analyzed health care use through data linkage with the Medicare Benefits Schedule databases, through the Australian Institute of Health and Welfare. This allowed Morrisroe and colleagues to evaluate hospital admissions, ED presentations and ambulatory care use and cost for 2008-2015.

According to the researchers, 48.6% of the included patients, or 527 individuals, demonstrated a digital ulcer during a mean follow-up of 5.2±2.5years. These patients were more likely to experience diffuse disease subtype, with a rate of 34.9% compared with 18.2% among patients without digital ulcers (P<.001). Those with digital ulcers were also more likely to have anti-Scl-70 antibody — 18.9% compared with 9.3% (P<.001) —and a younger age at disease onset — 43.6±13.9 years compared with 48.8±14.0years (P<.001).

In addition, patients with digital ulcers demonstrated reduced health-related quality of life, compared with those without, as measured by the SF-36, but without a significant impact on survival. Those with a history of digital ulcers used significantly more health care resources per year than those without, including hospitalizations, ED admissions and ambulatory care services. Total health care services, excluding medications, were associated with an annual excess cost of AUD $12,474 per patient with a digital ulcer (P<.001). This excess cost was driven by hospital and ED admissions.

“DUs are a serious complication of SSc and place a large burden on the health care system and the patient through reduced HRQoL, incremental health care resource utilization and associated cost without impacting survival,” Morrisroe and colleagues wrote. “To reduce the clinical burden of DUs, additional research is needed to determine effective interventions and management plans such as the development of a DU specific multidisciplinary clinic.” – by Jason Laday

Disclosure: The researchers report no relevant financial disclosures.