Cumulative Burden of Oral Corticosteroid Adverse Effects and the Economic Implications of Corticosteroid Use in Patients With Systemic Lupus Erythematosus

BackgroundSystemic lupus erythematosus (SLE or lupus) is an autoimmune multisystem disease. While a complete understanding of lupus’ origins, mechanisms, and progression is not yet available, a number of studies have demonstrated correlations between disease prevalence and severity, gender, and race. There have been few population based studies in the United StatesObjectivesTo assess temporal changes in demographics and hospital mortality of patients with lupus in Washington State from 2003 to 2011Study DesignThis study used data from the Healthcare Cost and Utilization Project (HCUP), a patient information database, and data from the Washington State census to study a group of patients in the state. Lupus hospitalizations were defined as any hospitalization with an ICD-9-CM diagnosis code for systemic lupus erythematosus. Regression analysis was used to assess the effect of calendar time on demographics and hospital outcomes.ResultsThere were a total of 18,905 patients in this study with a diagnostic code for lupus. The mean age of the group was 51.5 years (95% CI: 50.6-52.3) in 2003 and 51.3 years (95% CI: 50.6-52.0) in 2011. The population was 88.6% female. Blacks were 2.8 times more likely to have a lupus hospitalization than whites when compared to the Washington population. While hospital mortality decreased during this eight year period (3.12% in 2003 to 1.28% in 2011, p=0.001) hospital length of stay remained statistically unchanged at an average of 4.9 days during that eight year period. We found a significant decrease in annual hospital mortality over the study period [odds ratio(OR): 0.92 per year, 95% CI 0.88-0.96, P<0.001]. Hospital mortality was higher in males (2.6% male death to 1.8% female death)ConclusionsIn this large group of hospitalized lupus patients in Washington, hospital length of stay remained relatively stable over time but hospital mortality decreased by over 50% over the eight year study period.

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“…[9] Others have also used this billing code to classify patients with lupus for epidemiologic research. [10]…”

Section: Methodsmentioning

confidence: 99%

Significant Reductions in Mortality in Hospitalized Patients with Systemic Lupus Erythematosus in Washington State from 2003 to 2011

et al. 2015

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Chen

Choi

et al. 2015

Arthritis Care & Research

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Objective. To investigate the determinants of health care utilization and costs with use of glucocorticoid (GC) drugs among adult systemic lupus erythematosus (SLE) patients. Methods. This cross-sectional study analyzed established SLE patients identified by International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes from a large US insurance claims database in 2007-2011. Five patient groups were defined by their oral GC use during a 1-year period: non-GC users, <60 days of GC use, and ‡60 days of GC use in low dosage (£7.5 mg/day), medium dosage (>7.5 to £15 mg/day), or higher dosage (>15 mg/day). Annual health care utilization and costs were compared across these groups. Incremental costs of GC groups, calculated as the difference in total health care costs compared with those of the non-GC group, were estimated from multivariable regressions adjusting for demographic/clinical characteristics and stratified by concomitant immunosuppressant use. Results. A total of 50,230 SLE patients were identified (52% non-GC users, 20% <60 days of GC use, and 10% low dose, 10% medium dose, and 8% higher dose of ‡60 days of GC use). GC users had higher health care utilization and costs. Incremental costs were significant (all P < 0.01) for medium-dose ($5,319 and $6,913) and higher-dose ($12,517 and $15,019) GC groups, regardless of concomitant immunosuppressant use. The incremental costs for the low-dose GC group with concomitant immunosuppressants ($1,285; P 5 0.04) were smaller than the incremental costs for the low-dose GC group without concomitant immunosuppressants ($2,514; P < 0.01). Conclusion. GC use, especially at higher doses, was associated with higher health care utilization and costs. Findings in users with concomitant immunosuppressants suggest that therapies with a GC-sparing effect may be associated with lower economic burden in SLE treatment.

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“…In fact, Denburg, et al found actual improvement in mood following exposure to corticosteroid use (a dose of 0.5 mg/kg of prednisone daily for at least 6 months), but that small study included only 10 women with SLE 49 . In contrast, Shah, et al found an association of depression with corticosteroid use in a retrospective study of claims data in 2717 patients with SLE (p = 0.0443) 24 . Karol, et al found that a current prednisone dose higher than 7.5 mg per day was perhaps associated with depression in patients with SLE, although the association did not reach statistical significance (p = 0.07) 19 .…”

Section: Journal Of Rheumatologymentioning

confidence: 92%

“…SLE activity 7,10,13 , other neuropsychiatric manifestations 3,8,15,17 , or autoantibodies such as anticardiolipin (aCL) or anti-P lupus antibody 12,16 could directly predispose to depression. Depression could also be a secondary phenomenon caused by other manifestations of the disease (for instance, pain and arthritis 19 ), by corticosteroid therapy 24 , or as an emotional reaction to the chronicity or social stress caused by having SLE 1 . The results from past studies are inconsistent, with some studies finding no association between depression and disease activity 4,6,11,18,20 , other neuropsychiatric manifestations 6 , autoantibodies [e.g., anti-P 6,20 , antiphospholipid antibodies (aPL) 23 ], or corticosteroid usage 10,18 .…”

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confidence: 99%

Predictors of Incident Depression in Systemic Lupus Erythematosus

Huang

Magder²,

Petri³

2014

J Rheumatol

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Depression in SLE is multifactorial. Higher-dose prednisone (≥ 20 mg daily) is 1 important independent risk factor. Global disease activity is not a risk factor, but cutaneous activity and certain types of neurologic activity (myelitis) are predictive of depression. The independent effect of prednisone provides clinicians with an additional incentive to avoid and reduce high-dose prednisone exposure in SLE.

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Cumulative Burden of Oral Corticosteroid Adverse Effects and the Economic Implications of Corticosteroid Use in Patients With Systemic Lupus Erythematosus

Cited by 62 publications

References 15 publications

Significant Reductions in Mortality in Hospitalized Patients with Systemic Lupus Erythematosus in Washington State from 2003 to 2011

Significant Reductions in Mortality in Hospitalized Patients with Systemic Lupus Erythematosus in Washington State from 2003 to 2011

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

Predictors of Incident Depression in Systemic Lupus Erythematosus

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