Healthcare Utilization and Costs of Systemic Lupus Erythematosus by Disease Severity in the United States

Abstract

<jats:sec><jats:title>Objective</jats:title><jats:p> To quantify health care utilization and costs by disease severity for patients with systemic lupus erythematosus (SLE) in the United States </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> We conducted descriptive analyses of Humedica electronic health record (EHR) data from 2011 to 2015 (utilization analysis) and integrated Optum administrative claims/Humedica EHR data from 2012 to 2015 (cost analysis) for patients with SLE. All-cause utilization outcomes examined were hospitalizations, outpatient visits, emergency department (ED) visits, and prescription drug use. Analyses of costs stratified by disease severity were limited to patients enrolled in an Optum-participating health insurance plan for ≥1 year after the earliest observed SLE diagnosis date. Costs were converted to 2016 US dollars. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Health care utilization was evaluated in 17,257 patients with SLE. Averaged over the study period from 2011 to 2015, 13.7% of patients had ≥1 hospitalization per year, 25.7% had ≥1 ED visit, and 94.4% had ≥1 outpatient visit. Utilization patterns were generally similar across each year studied. Annually, 88.0% of patients had ≥1 prescription, including 1.3% who used biologics. Biologic treatment doubled between 2011 (0.7%) and 2015 (1.4%). Cost analyses included 397 patients. During 2012 to 2015, patients with severe SLE had mean annual costs of $52,951, compared with $28,936 and $21,052 for patients with moderate and mild SLE, respectively. Patients with severe SLE had increased costs in all service categories: inpatient, ED, clinic/office visits, and pharmacy. </jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p> US patients with SLE, especially individuals with moderate or severe disease, utilize significant health care resources and incur high medical costs.</jats:p></jats:sec>

Prevalence and Financial Burden of Digestive Diseases in a Commercially Insured Population

“…Although assessing the cost of non-GI conditions was out of the scope of this analysis, it is possible to provide some context using outside reference points. For example, the average all-cause cost for other conditions included $16,752 for diabetes, 28 $28,590 for coronary artery disease with angina, 29 $76,969 for stage 4-5 chronic kidney disease, 30 $52,951 for severe systemic lupus erythematosus, 31 $64,555 for sickle cell disease with 2 or more vaso-occlusive crises per year, 32 $18,829 for newly diagnosed multiple sclerosis, 33 and $16,654 for treatment-resistant major depressive disorder. 34 Taken holistically with differences in methodologies aside, the economic burden of digestive conditions in many cases exceeds that of other common and costly diseases.…”

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

“…2 Current medications approved by the US Food and Drug Administration to treat SLE include corticosteroids, antimalarials such as hydroxychloroquine, and belimumab, a biologic. [12][13][14][15][16][17] Other therapies for SLE management include nonsteroidal anti-inflammatory drugs (NSAIDs), immunosuppressive and/or immunomodulatory agents, and rituximab, a biologic. 18 Although corticosteroids provide clinical benefits, long-term use has been associated with organ damage and toxicity, along with increased healthcare resource utilisation (HCRU) and costs.…”

The Impact of Multidisciplinary Conferences on Healthcare Utilization in Chronic Pain Patients

“…The number of clinical visits (in person and telehealth) to pain providers, hospitalizations, ED visits, and pain medications were collected from patients' medical records for the year preceding enrollment in the conference and 1 year after enrollment. We also calculated total health care utilization (HCU) using our own equation (HCU = number of hospital visits + number of ED visits + number of physician visits) which we developed based on similar studies (16)(17)(18)(19). Included visits were specified as being related to pain or a therapy or intervention related to pain.…”

“…First, it is retrospective. Next, we created our own healthcare utilization score equation based on several studies utilizing a similar method (16)(17)(18)(19). Next, while we have a number of traditional providers in attendance at our MDC who are well versed in Western medicine, our team did not include alternative therapy such as chiropractic and acupuncture.…”