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

Abstract

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.

Drug History and SLE Laboratory Findings Among Iraqi Patients: A Hospital‐Based Study

“…In terms of nonsteroidal anti‐inflammatory drugs (NSAIDs), our study found that 49.0% of participants used these medications. This rate is significantly higher than the 35.5% reported in the study by Chen et al [32]. Our study also showed that 58% of patients were taking vitamin D, a finding that closely aligns with the study by Magro et al, which reported a similar rate of 57% [31].…”

Drug History and SLE Laboratory Findings Among Iraqi Patients: A Hospital‐Based Study

“…In terms of nonsteroidal anti‐inflammatory drugs (NSAIDs), our study found that 49.0% of participants used these medications. This rate is significantly higher than the 35.5% reported in the study by Chen et al [32]. Our study also showed that 58% of patients were taking vitamin D, a finding that closely aligns with the study by Magro et al, which reported a similar rate of 57% [31].…”

Healthcare resource use and cost associated with varying dosages of extended corticosteroid exposure in a US population

“…Given how large a proportion AE-related costs were found to be, it is important that clinicians carefully consider treatment options for patients with autoimmune and inflammatory diseases that are traditionally treated with corticosteroids. For context, in the current study, over 40% of patients in the extended corticosteroid use cohorts had at least one prescription for a selected non-steroid therapy in the follow-up period, consistent with Chen et al 11 .…”

Adverse Outcomes, Healthcare Resource Utilization, and Costs Associated with Systemic Corticosteroid use Among Adults with Systemic Lupus Erythematosus in the UK

“…The higher costs seen in the SCS exposure group compared with the non-SCS group are consistent with observations from previous analyses of US claims databases [ 19 – 21 ]. We found that patients receiving SCS doses of 7.5–15.0 mg, and those receiving high doses ≥ 15.0 mg, had increased annual costs of GBP 5242 and GBP 9096, respectively, compared with patients not receiving SCS.…”

“…We found that patients receiving SCS doses of 7.5–15.0 mg, and those receiving high doses ≥ 15.0 mg, had increased annual costs of GBP 5242 and GBP 9096, respectively, compared with patients not receiving SCS. These are similar to the increased costs identified by Chen et al [ 19 ]. Higher costs in patients receiving SCS could be attributed to more active disease in this patient group.…”

Drug History and SLE Laboratory Findings Among Iraqi Patients: A Hospital‐Based Study

“…In terms of nonsteroidal anti‐inflammatory drugs (NSAIDs), our study found that 49.0% of participants used these medications. This rate is significantly higher than the 35.5% reported in the study by Chen et al [32]. Our study also showed that 58% of patients were taking vitamin D, a finding that closely aligns with the study by Magro et al, which reported a similar rate of 57% [31].…”

Healthcare resource use and cost associated with varying dosages of extended corticosteroid exposure in a US population

“…Given how large a proportion AE-related costs were found to be, it is important that clinicians carefully consider treatment options for patients with autoimmune and inflammatory diseases that are traditionally treated with corticosteroids. For context, in the current study, over 40% of patients in the extended corticosteroid use cohorts had at least one prescription for a selected non-steroid therapy in the follow-up period, consistent with Chen et al 11 .…”

Adverse Outcomes, Healthcare Resource Utilization, and Costs Associated with Systemic Corticosteroid use Among Adults with Systemic Lupus Erythematosus in the UK

“…The higher costs seen in the SCS exposure group compared with the non-SCS group are consistent with observations from previous analyses of US claims databases [ 19 – 21 ]. We found that patients receiving SCS doses of 7.5–15.0 mg, and those receiving high doses ≥ 15.0 mg, had increased annual costs of GBP 5242 and GBP 9096, respectively, compared with patients not receiving SCS.…”

“…We found that patients receiving SCS doses of 7.5–15.0 mg, and those receiving high doses ≥ 15.0 mg, had increased annual costs of GBP 5242 and GBP 9096, respectively, compared with patients not receiving SCS. These are similar to the increased costs identified by Chen et al [ 19 ]. Higher costs in patients receiving SCS could be attributed to more active disease in this patient group.…”

Drug History and SLE Laboratory Findings Among Iraqi Patients: A Hospital‐Based Study

“…In terms of nonsteroidal anti‐inflammatory drugs (NSAIDs), our study found that 49.0% of participants used these medications. This rate is significantly higher than the 35.5% reported in the study by Chen et al [32]. Our study also showed that 58% of patients were taking vitamin D, a finding that closely aligns with the study by Magro et al, which reported a similar rate of 57% [31].…”

Healthcare resource use and cost associated with varying dosages of extended corticosteroid exposure in a US population

“…Given how large a proportion AE-related costs were found to be, it is important that clinicians carefully consider treatment options for patients with autoimmune and inflammatory diseases that are traditionally treated with corticosteroids. For context, in the current study, over 40% of patients in the extended corticosteroid use cohorts had at least one prescription for a selected non-steroid therapy in the follow-up period, consistent with Chen et al 11 .…”

Adverse Outcomes, Healthcare Resource Utilization, and Costs Associated with Systemic Corticosteroid use Among Adults with Systemic Lupus Erythematosus in the UK

“…The higher costs seen in the SCS exposure group compared with the non-SCS group are consistent with observations from previous analyses of US claims databases [ 19 – 21 ]. We found that patients receiving SCS doses of 7.5–15.0 mg, and those receiving high doses ≥ 15.0 mg, had increased annual costs of GBP 5242 and GBP 9096, respectively, compared with patients not receiving SCS.…”

“…We found that patients receiving SCS doses of 7.5–15.0 mg, and those receiving high doses ≥ 15.0 mg, had increased annual costs of GBP 5242 and GBP 9096, respectively, compared with patients not receiving SCS. These are similar to the increased costs identified by Chen et al [ 19 ]. Higher costs in patients receiving SCS could be attributed to more active disease in this patient group.…”