Economic Evaluation of Lupus Nephritis in the Systemic Lupus International Collaborating Clinics Inception Cohort Using a Multistate Model Approach

Barber, Megan R.W.; Hanly, John G.; Su, Li; Urowitz, Murray B.; Pierre, Yvan St.; Romero-Díaz, Juanita; Gordon, Caroline; Bae, Sang Cheol; Bernatsky, Sasha; Wallace, Daniel J.; Isenberg, David; Rahman, Anisur; Ginzler, Ellen M.; Petri, Michelle; Bruce, Ian N.; Fortin, Paul R.; Gladman, Dafna D.; Sánchez‐Guerrero, Jorge; Ramsey‐Goldman, Rosalind; Khamashta, Munther A.; Aranow, Cynthia; Mackay, Meggan; Alarcón, Graciela S.; Manzi, Susan; Nived, Ola; Jönsen, Andreas; Zoma, Asad; Vollenhoven, Ronald F. van; Ramos‐Casals, Manuel; Ruiz‐Irastorza, Guillermo; Lim, S. Sam; Kalunian, Kenneth C.; İnanç, Murat; Kamen, Diane L.; Peschken, Christine A.; Jacobsen, Søren; Askanase, Anca; Theriault, Chris; Farewell, Vernon; Clarke, Ann E.

doi:10.1002/acr.23480

Cited by 22 publications

(19 citation statements)

References 29 publications

(58 reference statements)

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“…About point of services, the inpatient ones were the most expensive in our study, in agreement with other authors who reported both hospitalizations and readmissions as sources of high direct costs. 16 In addition, as the complication advances, the 10-year cumulative costs magnify to approximately 23-fold, 9 which implies that an increase in costs is sometimes predictable and they might increase even before the diagnosis is made. 3 Therefore, the worsening of disease, although difficult, might be preventable or delayed if optimal patient follow-up and attention are achieved.…”

Section: Discussionmentioning

confidence: 99%

Direct cost of lupus care in the developing world: the case of Colombia

Prada

Pérez

Nieto-Aristizábal

et al. 2019

Lupus

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Background Lupus is a chronic autoimmune and incurable rheumatic disease and has a global prevalence of 3.2–517.5 cases per 100,000 people. However, currently there is no knowledge regarding the actual direct cost of patients with lupus to healthcare systems in developing countries. This study aimed to determine the direct cost of lupus care in Colombia. Methods To identify patients with lupus, claims data of 2 years from two health insurers were subjected to an algorithm according to International Statistical Classification of Diseases and Related Health Problems 10th Revision codes. Multivariate linear regression analyses were used to assess the direct cost of lupus care. Results The average annual per-patient, all-claims, all-cause direct cost was $2355; this is approximately 9 times the average annual premium received by health insurers for covering the public benefits package. Approximately 50% of direct costs are not included in the public benefits package. The incidence of one or more condition is 98.4%. The direct cost incurred by patients with two comorbidities was 1.8 times more, with three chronic conditions was 1.9 times more and with six chronic conditions was 4.5 times more than that incurred by patients with only lupus. Conclusions The direct cost of lupus care in the developing world may be higher than expected; in addition, access to healthcare may not be equal for the entire population.

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Section: Discussionmentioning

confidence: 99%

Direct cost of lupus care in the developing world: the case of Colombia

Prada

Pérez

Nieto-Aristizábal

et al. 2019

Lupus

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“…In the US study by Li et al [38], median annual medical costs for patients with SLE and ESKD increased by twofold between Year 1 and Year 5 (US$33,827-66,490), whereas ESKD was also found to be a significant independent contributor to treatment costs (p \ 0.001). In addition, Barber et al [27] reported that predicted mean annual costs related to ESKD were more than 17-fold higher than health states reflecting good renal function.…”

Section: Direct Costsmentioning

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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“…In previous research involving the SLICC inception cohort, we have used similar multistate modeling to estimate long-term direct costs associated with lupus nephritis. We demonstrated that those with lupus nephritis and an estimated glomerular filtration rate (GFR) <30 ml/minute incurred 10-year costs >15-fold than for patients without lupus nephritis and an estimated GFR >60 ml/minute (29). Other researchers have also reported an association between renal damage and direct costs, with one study of 715 patients showing that each unit increase in renal damage was associated with a 24% increase in 4-year direct costs, while there was no association between renal damage and indirect costs (i.e., those due to lost productivity) (30).…”

Section: Discussionmentioning

confidence: 99%

Economic Evaluation of Damage Accrual in an International Systemic Lupus Erythematosus Inception Cohort Using a Multistate Model Approach

Barber

Hanly

et al. 2020

Arthritis Care & Research

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Objective. There is a paucity of data regarding health care costs associated with damage accrual in systemic lupus erythematosus. The present study was undertaken to describe costs associated with damage states across the disease course using multistate modeling. Methods. Patients from 33 centers in 11 countries were enrolled in the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort within 15 months of diagnosis. Annual data on demographics, disease activity, damage (SLICC/American College of Rheumatology Damage Index [SDI]), hospitalizations, medications, dialysis, and selected procedures were collected. Ten-year cumulative costs (Canadian dollars) were estimated by multiplying annual costs associated with each SDI state by the expected state duration using a multistate model. Results. A total of 1,687 patients participated; 88.7% were female, 49.0% were white, mean ± SD age at diagnosis was 34.6 ± 13.3 years, and mean follow-up duration was 8.9 years (range 0.6-18.5 years).

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Economic Evaluation of Lupus Nephritis in the Systemic Lupus International Collaborating Clinics Inception Cohort Using a Multistate Model Approach

Cited by 22 publications

References 29 publications

Direct cost of lupus care in the developing world: the case of Colombia

Direct cost of lupus care in the developing world: the case of Colombia

The Economic Burden of Lupus Nephritis: A Systematic Literature Review

Economic Evaluation of Damage Accrual in an International Systemic Lupus Erythematosus Inception Cohort Using a Multistate Model Approach

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