A longitudinal analysis of costs associated with change in disease activity in systemic lupus erythematosus

Kan, Hong; Guérin, Annie; Kaminsky, Michael; Yu, Andrew P.; Wu, Eric Q.; Denio, Alfred; Jhingran, Priti; Narayanan, S.; Molta, Charles

doi:10.3111/13696998.2013.802241

Cited by 16 publications

(39 citation statements)

References 10 publications

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“…44,45 The total all-cause healthcare costs substantially increased by 71% during the post-index date period (US$26,998) compared with the pre-index date period (US$15,746). Kan et al 37 estimated an average of US$18,839 annual healthcare costs in patients with SLE, while other studies reported costs up to 3-fold higher among patients with SLE, 41,46 depending on SLE severity and payer type. Lowest costs were observed among patients with mild SLE covered by commercial insurers, while highest costs were observed among patients with moderate or severe SLE covered by Medicaid.…”

Section: Discussionmentioning

confidence: 99%

“…SLE disease severity (mild, moderate, and severe) and proportion of patients with flares by severity (mild, moderate, and severe) in the pre-and post-index date periods were identified using published algorithms. [36][37][38] HCRU outcomes encompassed inpatient admissions, emergency department (ED) visits, physician office visits, outpatient/other ancillary visits, and medication use, and were assessed during the pre-and post-index date periods. A list of the medications considered to be SLE-related is available in Supplementary material (Supplementary Table ).…”

Section: Variables and Outcome Measuresmentioning

confidence: 99%

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An evaluation of costs associated with overall organ damage in patients with systemic lupus erythematosus in the United States

Bell

Ajmera

Meyers

2022

Lupus

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Introduction Approximately 33–50% of patients with systemic lupus erythematosus (SLE) develop organ damage within 5 years of diagnosis. Real-world studies that capture the healthcare resource utilization (HCRU) and costs associated with SLE-related organ damage are limited. The aim of this study was to evaluate HCRU and costs associated with organ damage in patients with SLE in the USA. Methods This retrospective study (GSK study 208380) used the PharMetrics Plus administrative claims database from 1 January 2008 to 30 June 2019. Patients with SLE and organ damage were identified using International Classification of Diseases (ICD)-9/10 codes derived from the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index. The first observed diagnosis of organ damage was designated as the index date. Selection criteria included: ≥18 years of age; ≥1 inpatient or ≥2 outpatient claims for SLE (≥30 days apart before the index date; ICD-9: 710.0 or ICD-10: M32, excluding M32.0); ≥1 inpatient or ≥3 outpatient claims for organ damage within 6 months for the same organ system code; continuous enrollment of 12 months both pre- and post-index date. The proportion of patients with new organ damage, disease severity, SLE flares, SLE-related medication patterns, HCRU and all-cause costs (2018 US$) were assessed 12 months pre- and post-index date. Results Of the 360,803 patients with a diagnosis of SLE, 8952 patients met the inclusion criteria for the presence of new organ damage. Mean (standard deviation (SD)) age was 46.4 (12.2) years and 92% of patients were female. The most common sites of organ damage were neuropsychiatric (22.0%), ocular (12.9%), and cardiovascular (11.4%). Disease severity and proportion of moderate/severe flare episodes significantly increased from pre- to post-index date (p < 0.0001). Overall, SLE-related medication patterns were similar pre- versus post-index date. Inpatient, emergency department and outpatient claims increased from pre- to post-index date and mean (SD) all-cause costs were 71% higher post- versus pre-index date ($26,998 [57,982] vs $15,746 [29,637], respectively). Conclusions: The economic impact associated with organ damage in patients with SLE is profound and reducing or preventing organ damage will be pivotal in alleviating the burden for patients and healthcare providers.

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Section: Discussionmentioning

confidence: 99%

Section: Variables and Outcome Measuresmentioning

confidence: 99%

An evaluation of costs associated with overall organ damage in patients with systemic lupus erythematosus in the United States

Bell

Ajmera

Meyers

2022

Lupus

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“…However, higher costs have been reported for patients with LN [14,16], with a mean annual direct cost range of US$29,034-$62,651 [14]. Increased disease activity and organ damage have also been shown to increase costs in patients with SLE [17][18][19][20]. Despite this, few studies have evaluated the economic burden of the subgroup of patients with LN.…”

Section: Introductionmentioning

confidence: 99%

The Economic Burden of Lupus Nephritis: A Systematic Literature Review

Thompson¹,

Mahajan²,

Scott³

et al. 2021

Rheumatol Ther

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Introduction Few studies have evaluated the economic burden of lupus nephritis (LN). The aim of this systematic literature review (SLR) was to assess the economic burden (direct and indirect costs, and healthcare resource utilization [HCRU]) associated with LN, with particular focus on the burden of renal flares and end-stage kidney disease (ESKD). Methods This SLR (GSK study 213531) was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Searches of the MEDLINE and Embase databases were conducted for English language publications reporting cost or HCRU data in patients with LN (regardless of age or LN histological class) until December 10, 2019. Handsearching of conference proceedings and keyword-based searches in PubMed, Google, and Google Scholar were also conducted. Results Twenty-two studies were identified from 28 publications reporting the cost ( n = 19) and HCRU ( n = 13) associated with LN. Most studies were from North America ( n = 13) and many used administrative claims data ( n = 9). LN was associated with substantially higher direct costs (e.g., total annual, hospitalization, and ESKD-related direct costs), total indirect costs, and HCRU (e.g., hospitalization, outpatient services, and medication use) compared with patients without systemic lupus erythematosus (SLE) or non-renal SLE controls. ESKD and dialysis were significant contributors to economic burden. No studies described the cost of renal flares. Conclusions The consensus across the 22 studies was that the economic burden of LN is substantial, particularly in active or severe disease, or if there is progression to ESKD. Total direct cost may be underestimated in claims data given the challenges of identifying patients with LN. Further studies are vital to ascertain the cost of renal flares; a renal flare is likely to result in a period of increased HCRU, which could be mitigated by treatments that extend renal remission. Supplementary Information The online version contains supplementary material available at 10.1007/s40744-021-00368-y.

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“…Analyses were also conducted to examine the relation of clinician-recorded SLEDAI scores and eSLEDAI score categories to healthcare resource utilisation, pain medication prescriptions and corticosteroid prescriptions, as previous studies have shown that resource utilisation including medication usage increases with increased disease activity. 11 12 While a comparison of the eSLEDAI score category to a clinician-recorded SLEDAI score cannot be done for these SLE Registry encounters, the performance of the model can still be assessed based on other types of medical data. In these analyses, we compared trends in healthcare resource utilisation, pain medication prescriptions and corticosteroid prescriptions across the four estimated SLEDAI categories to trends across clinician-recorded SLEDAI scores as independent measures of the model’s performance in a real-world dataset.…”

Section: Methodsmentioning

confidence: 99%

Validation of a machine learning approach to estimate Systemic Lupus Erythematosus Disease Activity Index score categories and application in a real-world dataset

et al. 2021

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ObjectiveUse of the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) in routine clinical practice is inconsistent, and availability of clinician-recorded SLEDAI scores in real-world datasets is limited. This study aimed to validate a machine learning model to estimate SLEDAI score categories using clinical notes and to apply the model to a large, real-world dataset to generate estimated score categories for use in future research studies.MethodsA machine learning model was developed to estimate an individual patient’s SLEDAI score category (no activity, mild activity, moderate activity or high/very high activity) for a specific encounter date using clinical notes. A training cohort of 3504 encounters and a separate validation cohort of 1576 encounters were created from the OM1 SLE Registry. Model performance was assessed using the area under the receiver operating characteristic curve (AUC), calculated using a binarised version of the outcome that sets the positive class to be those records with clinician-recorded SLEDAI scores >5 and the negative class to be records with scores ≤5. Model performance was evaluated by categorising the scores into the four disease activity categories and by calculating the Spearman’s R value and Pearson’s R value.ResultsThe AUC for the two categories was 0.93 for the development cohort and 0.91 for the validation cohort. The model had a Spearman’s R value of 0.7 and a Pearson’s R value of 0.7 when calculated using the four disease activity categories.ConclusionThe model performs well when estimating SLEDAI score categories using unstructured clinical notes.

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A longitudinal analysis of costs associated with change in disease activity in systemic lupus erythematosus

Abstract: Only short-term effects of disease activity change were investigated, disregarding other potential benefits of low disease activity on long-term organ damage prevention or comorbidities.

Cited by 16 publications

References 10 publications

An evaluation of costs associated with overall organ damage in patients with systemic lupus erythematosus in the United States

An evaluation of costs associated with overall organ damage in patients with systemic lupus erythematosus in the United States

The Economic Burden of Lupus Nephritis: A Systematic Literature Review

Validation of a machine learning approach to estimate Systemic Lupus Erythematosus Disease Activity Index score categories and application in a real-world dataset

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