Real-world treatment patterns, healthcare resource utilisation and costs in patients with systemic lupus erythematosus treated with belimumab: a retrospective analysis of claims data in the USA

Abstract

ObjectiveTo examine the effects of belimumab initiation on healthcare resource utilisation (HCRU) and costs in SLE.MethodsThis retrospective observational cohort study used healthcare administrative claims data from the IBM MarketScan Commercial Claims and Encounters Database to identify patients with SLE billing codes who received ≥1 intravenous belimumab infusion between March 2011 and December 2015. The first belimumab administration was the ‘index date’. During the 6-month postindex period, nine belimumab infusions were recommended: three during the initiation period and six during the maintenance period. HCRU and cost data for inpatient admissions, emergency department visits, physician office visits, hospital-based outpatient visits, laboratory services, other outpatient services and outpatient pharmacy prescriptions were compared in the 6-month pre/postindex periods.ResultsOf the 1879 patients with SLE included, 43% received ≥3 intravenous initiation administrations. An average of 5.3 (SD: 2.4) of the nine recommended belimumab administrations were received within 6 months. In the 6-month preindex versus postindex periods, significant reductions were noted for inpatient hospitalisations (18% vs 9%, p<0.001; mean visits: 0.3 vs 0.14, p<0.001) and emergency department visits (40% vs 24%, p<0.001; mean visits; 3.53 vs 1.96, p<0.001). Mean total costs were higher in the 6-month postindex versus preindex period ($41 426 vs $29 270; p<0.001).ConclusionsIn this study of real-world intravenous belimumab for SLE, adherence to recommended infusion schedules was low. Outpatient healthcare and associated costs were higher in the 6 months after belimumab was initiated, although inpatient costs were lower. Reasons for non-adherence with belimumab and implications should be investigated.

Corticosteroid dosing and opioid use are high in patients with SLE and remain elevated after belimumab initiation: a retrospective claims database analysis

“…Future research restricted to patients receiving care from specialists, such as rheumatologists, nephrologists and dermatologists, would likely provide a population with more severe and active SLE, more lupus nephritis, proteinuria and comorbidities, and should be pursued. Our findings match both clinical trials and observational studies that have shown high frequency of steroid use 25 and a steroid-sparing effect after treatment with belimumab. [26][27][28] Our analysis also showed a decrease in usage of oral corticosteroids during the 6 months after initiation of belimumab (compared with the 6 months prior to initiation), confirming similar studies that found a significant decrease in oral steroids before and after belimumab use.…”

“…Our findings match both clinical trials and observational studies that have shown high frequency of steroid use 25 and a steroid-sparing effect after treatment with belimumab. 26–28 Our analysis also showed a decrease in usage of oral corticosteroids during the 6 months after initiation of belimumab (compared with the 6 months prior to initiation), confirming similar studies that found a significant decrease in oral steroids before and after belimumab use.…”

“… 26–28 Our analysis also showed a decrease in usage of oral corticosteroids during the 6 months after initiation of belimumab (compared with the 6 months prior to initiation), confirming similar studies that found a significant decrease in oral steroids before and after belimumab use. 25 Unlike oral steroids, intravenous steroid use increased pre-to-post belimumab use for the intravenous belimumab patients, consistent with data published by Bell et al . 25 The opposite trend was observed in subcutaneous belimumab patients: use of intravenous steroids decreased.…”

“… 25 Unlike oral steroids, intravenous steroid use increased pre-to-post belimumab use for the intravenous belimumab patients, consistent with data published by Bell et al . 25 The opposite trend was observed in subcutaneous belimumab patients: use of intravenous steroids decreased. We hypothesise that intravenous steroids may have been administered to reduce infusion reactions, which can be common in intravenous treatment of SLE and other rheumatic diseases.…”

The effects of different lookback periods on the sociodemographic structure of the study population and on the estimation of incidence rates: analyses with German claims data

“…Selection problems as described here may not only occur in German claims data, but in all databases where individuals may not be represented over the whole life course or over a very long time period. This applies to health care systems where different insurance funds or different insurance systems are coexisting as is the case e.g., in Switzerland [ 31 ] or the USA [ 32 , 33 ], but also in registries where data do not cover the whole population or are censored. In the last decades the use of claims and registry data has increased leading to the increased importance of the topics discussed in this paper.…”