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

Abstract

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.

Annual Direct Cost and Cost-Drivers of Systemic Lupus Erythematosus: A Multi-Center Cross-Sectional Study from CSTAR Registry

“…The dominant cost-drivers were found to be hospitalization, use of biologics, moderate to high dose glucocorticoids, major organ involvements (e.g., cardiovascular, kidney, peripheral vascular system), disease status, and severity of the disease. These findings were consistent with previous studies [ 8 , 14 , 20 , 21 , 35 , 36 ]. The findings provided evidence that the interventions achieved to effectively control disease activity, prevent disease flareups, delay, or slow disease progression might potentially save large amounts of direct costs, especially attributable to disease progression and cumulative organ damage [ 37 , 38 ].…”

“…Some cost-drivers (e.g., young age, high disease activity, more organs damaged, exacerbation of the disease, flares, impaired physical or mental health due to SLE, etc. ), were also identified in previous studies; however, there have been disparities across studies [ 8 , 20 , 21 , 22 , 23 ]. The patients with SLE were different in the clinical features, socioeconomic status, ethnic profiles, coverage of health insurance, access to health resources, etc., which accounted for the disparities in these studies, to a certain extent.…”

The cost of flares among patients with systemic lupus erythematosus with and without lupus nephritis in the United States

“…This observation is likely an explanation for the greater average age of the cohorts identified for this study (LN cohort, 65.0; non-LN cohort, 58.0) compared with patients with SLE from other claims-based studies (41.4-52.7). 24,[38][39][40][41][42][43] Bias may also have been introduced by using two sets of diagnoses codes (ICD-9 and ICD-10) to identify patients and flare severity. No specific SLE flare diagnosis codes exist, so this study relied on a claims-based algorithm to define the presence of flares.…”

“…In this study, use of antimalarials was only measured during the 12-month pre-index period, before the earliest diagnosis of SLE; however, the values reported here fall within the range reported by other claims-based studies (16.4%-78.6%). 24,[38][39][40][41][42][43] Yet, when examining data from a lupus center of excellence, for example, the Johns Hopkins Cohort, 95% of patients had used hydroxychloroquine between 2010 and 2019. 44 Finally, not all Medicare plans or patients are represented in the Optum Clinformatics database.…”

Lupus nephropathy beyond immunosuppression: Searching for nephro and cardioprotection

“…Systemic lupus erythematosus (SLE) is defined as a chronic autoimmune disease with alternating periods of quiescence and disease flares (1). Approximately 30% to 50% of SLE patients will develop some level of organ injury within five years of diagnosis and 50% or more within ten years of diagnosis (2). SLE patients frequently develop lupus nephritis (LN) that can progress to end-stage renal disease (ESKD), with a risk between 10% and 30% at 15 years in patients with severe LN (classes III, IV, and V) (3).…”