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.

A Retrospective Analysis of Corticosteroid Utilization Before Initiation of Biologic DMARDs Among Patients with Rheumatoid Arthritis in the United States

“…While the literature is more limited concerning the impact of corticosteroid use on healthcare costs in the RA population, similar findings have been noted in studies of corticosteroid use in other chronic autoimmune disease populations. For example, a study by Chen et al among patients with systemic lupus erythematosus found that glucocorticoid users compared to non-users had significantly greater healthcare utilization and costs [34]. Although our findings suggest that RA patients who use corticosteroids incur greater healthcare utilization and costs than those who do not, the reasons for this pattern are not known.…”

Long-term Systemic Corticosteroid Exposure: A Systematic Literature Review

“…Following the title/abstract and full-text reviews, data from 32 articles were extracted. 3,4,9,11,13, This count of articles was proportionally similar to those identified by Manson et al, 3 given the difference in the time periods considered. Figure 3 and Table II summarize the characteristics of the 32 articles extracted.…”

Restrictive Use of Oral Glucocorticoids in Systemic Lupus Erythematosus and Prevention of Damage Without Worsening Long‐Term Disease Control: An Observational Study

“…The median time to first damage of the whole cohort was 3 years, with almost 20% of patients accruing damage within the first year; similar numbers have recently been reported by the SLICC group . Therefore, damage prevention should be a priority from the very first visit , since it has been demonstrated that damage causes further damage, deteriorates quality of life, and increases the costs of patients’ care .…”