Burden of corticosteroid use in patients with systemic lupus erythematosus: results from a Delphi panel

Abstract

Corticosteroid-related adverse events (AEs) are commonly reported in systemic lupus erythematosus (SLE), but are often under-represented in claims data. The most common corticosteroid-related AEs are not necessarily the most costly. The present study aimed to examine corticosteroid-related AE rates and identify the associated cost consequences in patients with SLE from the perspective of rheumatologists treating SLE in the United States (US). A modified Delphi process and RAND Appropriateness Method was used to estimate corticosteroid-related AEs and costs based on data from SLE-treating US rheumatologists and estimates from alternative sources. The panel (n=10) participated in two web-based questionnaires, covering disease severity, corticosteroid use, corticosteroid-related AEs, and resource utilization associated with treatment of the AEs. Eight members of the panel then participated in a guided discussion by interactive teleconference, in which the costs associated with specific corticosteroid-related AEs were also discussed. Consensus was achieved in the teleconference when a single response category (consensus values from 1 to 4 [4=strongly agree, 1=strongly disagree]) accounted for ≥80% of responses. Thirteen consensus statements were developed following two Delphi rounds. Costs were estimated for eight corticosteroid-associated AEs from the panel of rheumatologists. In the patients with SLE treated by these physicians, 41.5% were considered to have mild disease, 36.5% moderate disease, and 22.0% severe disease. The number of specialist visits, corticosteroid use, and corticosteroid dose increased with disease severity. The estimated rates of all AEs (except for cataracts) were at least doubled in patients receiving corticosteroid doses>20 mg/day compared with ≤20 mg/day. The highest estimated mean total costs of an event (for the required treatment duration for one patient) were for avascular necrosis ($14,460) and serious infection ($11,660). The costs of more common AEs, such as osteoporosis, obesity, diabetes, and fractures, ranged from $1190 to $8220. Ten rheumatologists concluded that as disease severity increases, corticosteroid doses increased. Greater utilization of resources is needed to manage patients and corticosteroid-related AEs.

Glucocorticoid Use in Patients With Systemic Lupus Erythematosus: Association Between Dose and Health Care Utilization and Costs

“…In our study sample, GC costs were on average $50 per person per year among users with $60 days of use, regardless of dose. Two likely explanations are that higher disease severity confounds the observed relationship between high GC doses and costs, especially in a cross-sectional design, and/or that events specifically related to higher GC doses, such as GC-related adverse events, may increase the costs (15,25). Future studies using longitudinal designs with additional data on disease features would identify the driving factors of the association between dose of GCs and costs of SLE.…”

“…Many GC-related adverse events require substantial health care resource utilization and are potentially costly (14,15). Therefore, limiting exposure to GCs by concomitant GCsparing therapy could potentially improve the patient's quality of life and reduce the GC-associated economic burden.…”

The effects of corticosteroids on cognitive flexibility and decision-making in women with lupus

“…However, while corticosteroid treatment is indispensible for controlling the disease in some cases, it does produce adverse effects, some of which can lead to major organ damage. 1,4,5 The adverse effects of corticosteroid treatment and organ damage in SLE patients have been broadly studied and reviewed and reveal major implications. cognitive deficits in SLE patients.…”

Evaluation of Sleep Quality by Actigraphy in Women with Systemic Lupus Erythematosus (SLE)

“…The increase in sleep latency has also been observed in other studies [10,43], although only subjective evaluation tools were used for assessing sleep quality, such as PSQI, and higher scores and greater fatigue intensity worsened the perception of quality of life [12]. In the present study a cause-effect relationship of this cannot be established, due to the cross-sectional nature and small sample, but we may hypothesize that high pain intensity has a role in perception of quality of life and indirectly in sleep quality, as indicated in a recent study of [44].…”

“…The presence of cytokines, responsible for the inflammatory process, disease activity, the chronic use of corticosteroids that affect the sleepwake cycle, psychological factors, and disability in valued life activities, can impair sleep quality, increase levels of pain and fatigue, and worsen depressive mood, causing work withdrawals, help to be required to perform simple tasks (such as cleaning the house), abandonment of social activities, and isolation with a consequent negative impact on perception of quality of life [1,[6][7][8][9][10][11][12][13][14].…”