Disease and economic burden increase with systemic lupus erythematosus severity 1 year before and after diagnosis: a real-world cohort study, United States, 2004–2015

Abstract

ObjectiveTo assess the economic burden of patients with SLE by disease severity in the USA 1 year before and after diagnosis.MethodsPatients aged ≥18 years with a first SLE diagnosis (index date) between January 2005 and December 2014 were identified from administrative commercial claims data linked to electronic medical records (EMRs). Disease severity during the year after diagnosis was classified as mild, moderate, or severe using claims-based algorithms and EMR data. Healthcare resource utilisation (HCRU) and all-cause healthcare costs (2017 US$) were reported for 1 year pre-diagnosis and post-diagnosis. Generalised linear modelling examined all-cause costs over 1 year post-index, adjusting for baseline demographics, clinical characteristics, Charlson Comorbidity Index and 1 year pre-diagnosis costs.ResultsAmong 2227 patients, 26.3% had mild, 51.0% moderate and 22.7% severe SLE. Mean per-patient costs were higher for patients with moderate and severe SLE compared with mild SLE during the year before diagnosis: mild US$12 373, moderate $22 559 and severe US$39 261 (p<0.0001); and 1-year post-diagnosis period: mild US$13 415, moderate US$29 512 and severe US$68 260 (p<0.0001). Leading mean cost drivers were outpatient visits (US$13 566) and hospitalisations (US$10 252). Post-diagnosis inpatient utilisation (≥1 stay) was higher for patients with severe (51.2%) and moderate (22.4%) SLE, compared with mild SLE (12.8%), with longer mean hospital stays: mild 0.47 days, moderate 1.31 days and severe 5.52 days (p<0.0001).ConclusionHCRU and costs increase with disease severity in the year before and after diagnosis; leading cost drivers post-diagnosis were outpatient visits and hospitalisations. Earlier diagnosis and treatment may improve health outcomes and reduce HCRU and costs.

Real-world burden of systemic lupus erythematosus in the USA: a comparative cohort study from the Medical Expenditure Panel Survey (MEPS) 2016–2018

“… 7 The proportion of adults with SLE with any office-based provider visit was 98% in the present study, which was similar to the proportions of between 86% and 100% reported in other US-based population studies. 25–27 The proportion of adults with SLE with reported emergency room visits in the present study was 31%, which fit within the reported range of 22%–58% for other US studies. 25–27 …”

“… 25–27 The proportion of adults with SLE with reported emergency room visits in the present study was 31%, which fit within the reported range of 22%–58% for other US studies. 25–27 …”

“…These findings were similar to those from a 2013 Medicare retrospective study, which found 2.2 times more outpatient visits and 2.1 times more emergency room visits for adults with SLE compared with non-SLE adults 7. The proportion of adults with SLE with any office-based provider visit was 98% in the present study, which was similar to the proportions of between 86% and 100% reported in other US-based population studies 25–27. The proportion of adults with SLE with reported emergency room visits in the present study was 31%, which fit within the reported range of 22%–58% for other US studies 25–27…”

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

“…Additionally, increases in the frequency and severity of flares as well as greater disease severity were found to directly correlate with higher healthcare cost in the MarketScan databases between 2005 and 2014. 44 , 45 …”

Assessment of medication-related burden among a sample of Iraqi patients with systemic lupus erythematosus and its relationship with disease activity: a cross-sectional study

“…Nonsteroidal anti-inflammatory drugs (NSAIDs), immunosuppressive and immunomodulatory drugs and rituximab are further treatments for the management of SLE. 7 The idea of "medication-related burden" (MRB) or "treatment burden" succinctly describes the entire workload that patients are subject to as a result of using healthcare, with several harmful effects on their lives. 8 Because medications are the primary method of managing most disorders, MRB is a significant portion of the overall treatment burden and is commonly mentioned in qualitative studies.…”