A structured literature review of the direct costs of adult systemic lupus erythematosus in the US

Abstract

Objective. A structured review of the literature was undertaken to examine the direct costs of adult systemic lupus erythematosus (SLE) in a US population. Methods. English-language studies published from January 2000 to April 2010 were systematically reviewed from both Medline's PubMed and the Cochrane databases. Studies were included if they reported direct medical costs of SLE among adults in the US. Results. Seven studies published since January 2000 that reported direct medical costs associated with SLE in the US were identified. Studies examined main cost categories of inpatient, outpatient, and pharmacy services; each contributed substantially to total costs. Wide SDs were reported, consistent with variability in disease manifestation. Mean annual direct costs of SLE patients ranged from $13,735-$20,926; the costs of those with and without nephritis ranged from $29,034 -$62,651 and $12,273-$16,575, respectively. Across studies of a general SLE population, pharmaceutical costs composed 19 -30% of total expenditures, with inpatient costs accounting for 16 -50% and outpatient costs accounting for 24 -56% of overall costs. Methodologies varied across studies, with patient self-reported resource utilization generating the lowest estimates versus claims-based analyses; Medicaid claims analyses generated lower incremental cost estimates for SLE patients versus control patients compared to estimates based on commercial claims analysis. Conclusion. SLE is associated with substantial annual direct cost burden in the US; however, little research has been done examining costs associated with specific treatments or cost variation by disease severity and disease manifestations. Future research elucidating the causes in variation of costs will help in the appraisal of emerging therapies and in developing clinical management strategies.

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

“…The majority of cases occur in women of child-bearing age (1). SLE is a costly condition to treat, with direct medical costs ranging from $13,735-20,926 in the US (4). More recent studies estimated the total annual health care costs for SLE patients could be as high as $17,155 (in 2009 US dollars) more than those of patients without SLE (5,6).…”

National Trends in Pediatric Systemic Lupus Erythematosus Hospitalization in the United States: 2000–2009

“…Several studies of adults with SLE in the United States (US) have found high resource utilization in these patients [2, 3], and a study of US hospitalizations for adult SLE found that 1 in 30 hospitalizations resulted in death [4]. Few studies also describe increased healthcare utilization for children with SLE [5-7]; however, the relationship of resource utilization and outcomes such as mortality remains unclear.…”

A longitudinal analysis of costs associated with change in disease activity in systemic lupus erythematosus

“…Despite a number of studies focusing on the overall economic burden of SLE, there is a lack of research on the costs associated with different disease severities and manifestations 3 . The few studies that have attempted to estimate this relationship applied cross-sectional designs.…”

“…It impairs patients' quality-of-life and poses substantial economic burdens in terms of direct healthcare expenditures and indirect costs associated with disability, absenteeism, lower productivity, and unemployment. A review of cost-of-illness studies on SLE estimated that the average direct healthcare costs per patient-year ranged from $3735-$14,410, with two estimates based on claims data of $$13,000 per year in the US 3 . SLE patients with organ damage, such as nephritis, incurred substantially higher costs 4 .…”