Healthcare utilization and cost of systemic lupus erythematosus in a US managed care health plan

Garris, Cindy; Jhingran, Priti; Bass, Damon; Engel-Nitz, Nicole; Riedel, Aylin Altan; Dennis, Greg

doi:10.3111/13696998.2013.778270

Cited by 95 publications

(168 citation statements)

References 37 publications

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“…Among GC users, more than half were prescribed with at least 60 days of therapy. In particular, close to two-thirds of the patients using GCs for more than 60 days were prescribed with a daily prednisone or equivalent dose of .7.5 mg. Our study reported the average annual total cost of all SLE patients to be $21,535, which was similar to what has been reported previously for the commercially insured population ($15,000-21,000) (5,23,24). We further found that higher GC doses were associated with higher health care utilization and costs.…”

Section: Discussionsupporting

confidence: 89%

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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Section: Discussionsupporting

confidence: 89%

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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“…Previous studies have demonstrated that both are higher in patients with SLE compared to controls (5,10,19,20). The current study confirms this observation, but also demonstrates a consistent change in the pattern of utilization over the 13 years of observation.…”

Section: Discussionsupporting

confidence: 89%

“…Studies of health care utilization have consistently found that it is higher in SLE patients than in comparator groups of patients (4,5,10,16). Utilization may be influenced by a variety of factors, including disease severity (17) (higher in lupus nephritis [8,16] and neuropsychiatric lupus [11,16]), race and ethnicity (lower in Hispanics [18]), and the type of health care delivery (higher in the fee-for-service system [3]).…”

Section: Discussionmentioning

confidence: 99%

Utilization of Ambulatory Physician Encounters, Emergency Room Visits, and Hospitalizations by Systemic Lupus Erythematosus Patients: A 13‐Year Population Health Study

Hanly

Thompson

Skedgel

2016

Arthritis Care & Research

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Objective. To determine total physician encounters, emergency room (ER) visits, and hospitalizations in an incident cohort of systemic lupus erythematosus (SLE) cases and matched control patients over 13 years. Methods. A retrospective cohort study was performed utilizing administrative health care data from approximately 1 million people with access to universal health care. Using International Classification of Diseases, Ninth and Tenth Revisions diagnostic codes, 7 SLE case definitions were used. Each case was matched by age and sex to 4 randomly selected controls. Data included physician billings, ER visits, and hospital discharges over 13 years.Results. The number of incident SLE cases varied from 564 to 4,494 depending on the case definition used. The mean age varied from 47.7 to 50.6 years and the proportion of females from 78.0% to 85.1%. SLE utilization of physicians was highest in the index year, and declined significantly thereafter for all case definitions. By the fourth year, encounters with subspecialty physicians fell by 60% (rheumatologists), 50% (internists), and 31% (other physicians). In contrast, visits to family physicians fell by only 9%. Visits to the ER and hospital admissions for SLE cases were also more frequent early in the disease course and fell significantly over the study for both ER visits (all case definitions) and hospitalizations (2 of 7 case definitions). Conclusion. In SLE patients, health care utilization is highest in the first few years following the diagnosis, which is also the time of maximal involvement by rheumatologists. Utilization declines over time, and encounters with patients' family physicians predominate over those of other physician groups.

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“…1–3,8–19 Annual costs associated with SLE are estimated to be $10,000–50,000 more than those for patients without SLE, with severe flares and more major organ involvement incurring the highest costs. 20–40 Major cost drivers include areas where AAs with lupus are disproportionately represented, such as inpatient hospitalizations, 36,41,42 long disease duration, high disease activity and organ damage, poor physical and mental health and low education and employment levels.…”

Section: Introductionmentioning

confidence: 99%

Effective Self-Management Interventions for Patients With Lupus: Potential Impact of Peer Mentoring

Williams

Egede

Faith

et al. 2017

The American Journal of the Medical Sciences

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Systemic lupus erythematosus (SLE) is associated with significant mortality, morbidity and cost for the individual patient and society. In the United States, African Americans (AAs) have 3–4 times greater prevalence of lupus, risk of developing lupus at an earlier age and lupus-related disease activity, organ damage and mortality compared with whites. Evidence-based self-management interventions that incorporate both social support and health education have reduced pain, improved function and delayed disability among patients with lupus. However, AAs and women are still disproportionately affected by lupus. This article presents the argument that peer mentoring may be an especially effective intervention approach for AA women with SLE. SLE peers with a track record of success in lupus management and have a personal perspective that clinicians often lack. This commonality and credibility can establish trust, increase communication and, in turn, decrease disparities in healthcare outcomes.

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Healthcare utilization and cost of systemic lupus erythematosus in a US managed care health plan

Abstract: SLE is associated with high levels of healthcare utilization and costs in a managed care health plan. Inpatient hospital stays were the primary medical cost drivers, followed by physician office visits and outpatient hospital visits.

Cited by 95 publications

References 37 publications

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

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

Utilization of Ambulatory Physician Encounters, Emergency Room Visits, and Hospitalizations by Systemic Lupus Erythematosus Patients: A 13‐Year Population Health Study

Effective Self-Management Interventions for Patients With Lupus: Potential Impact of Peer Mentoring

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