Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/124044
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Type: Journal article
Title: Digital ulcers in systemic sclerosis: their epidemiology, clinical characteristics, and associated clinical and economic burden
Author: Morrisroe, K.
Stevens, W.
Sahhar, J.
Ngian, G.-.S.
Ferdowsi, N.
Hill, C.L.
Roddy, J.
Walker, J.
Proudman, S.
Nikpour, M.
Citation: Arthritis Research and Therapy, 2019; 21(1):299-1-299-12
Publisher: Springer Nature
Issue Date: 2019
ISSN: 1478-6354
1478-6362
Statement of
Responsibility: 
Kathleen Morrisroe, Wendy Stevens, Joanne Sahhar, Gene-Siew Ngian, Nava Ferdowsi, Catherine L. Hill, Janet Roddy, Jennifer Walker, Susanna Proudman, and Mandana Nikpour
Abstract: 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.
Keywords: Systemic sclerosis; scleroderma; digital ulceration; economic burden
Rights: © The Author(s). 2019 Open Access This 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.
RMID: 1000011854
DOI: 10.1186/s13075-019-2080-y
Grant ID: http://purl.org/au-research/grants/nhmrc/1126370
Appears in Collections:Medicine publications

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