Economic Evaluation of Damage Accrual in an International Systemic Lupus Erythematosus Inception Cohort Using a Multistate Model Approach

Barber, Megan R.W.; Hanly, John G.; Su, Li; Urowitz, Murray B.; Pierre, Yvan St.; Romero-Díaz, Juanita; Gordon, Caroline; Bae, Sang Cheol; Bernatsky, Sasha; Wallace, Daniel J.; Merrill, Joan T.; Isenberg, David; Rahman, Anisur; Ginzler, Ellen M.; Petri, Michelle; Bruce, Ian N.; Dooley, Mary Anne; Fortin, Paul R.; Gladman, Dafna D.; Sánchez‐Guerrero, Jorge; Steinsson, Kristján; Ramsey‐Goldman, Rosalind; Khamashta, Munther A.; Aranow, Cynthia; Mackay, Meggan; Alarcón, Graciela S.; Manzi, Susan; Nived, Ola; Jönsen, Andreas; Zoma, Asad; Vollenhoven, Ronald F. van; Ramos‐Casals, Manuel; Ruiz‐Irastorza, Guillermo; Lim, S. Sam; Kalunian, Kenneth C.; İnanç, Murat; Kamen, Diane L.; Peschken, Christine A.; Jacobsen, Søren; Askanase, Anca; Farewell, Vernon; Stoll, Thomas; Buyon, Jill P.; Clarke, Ann E.

doi:10.1002/acr.24092

Cited by 28 publications

(43 citation statements)

References 39 publications

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“…negative impact in physical functioning, health-related quality of life, and life expectancy), 21,39 and higher healthcare costs compared with patients with less severe damage. 30,40 Our observational retrospective study provides important insights into the burden of SLE-associated organ damage across multiple organ domains in adult patients with SLE in real-world settings in the USA. Analysis of administrative claims data before and after diagnosis of the first site of organ damage demonstrated a substantial increase in annual HCRU and costs in patients with SLE who developed organ damage.…”

Section: Discussionmentioning

confidence: 99%

“…negative impact in physical functioning, health-related quality of life, and life expectancy), 21 , 39 and higher healthcare costs compared with patients with less severe damage. 30 , 40 …”

Section: Discussionmentioning

confidence: 99%

“…27,28 Organ damage is associated with a substantial economic burden, with previous studies showing significantly greater healthcare cost accrued for patients with organ damage than for those without. 10,18,[29][30][31] Despite the strong correlation between organ damage and increased healthcare costs, morbidity and mortality, 18,27,28,32 recent real-world studies on the impact of organ damage in SLE on healthcare costs and healthcare resource utilization (HCRU) are limited. While the SDI and other clinician-reported outcome measures (e.g.…”

Section: Introductionmentioning

confidence: 99%

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An evaluation of costs associated with overall organ damage in patients with systemic lupus erythematosus in the United States

Bell

Ajmera

Meyers

2022

Lupus

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Introduction Approximately 33–50% of patients with systemic lupus erythematosus (SLE) develop organ damage within 5 years of diagnosis. Real-world studies that capture the healthcare resource utilization (HCRU) and costs associated with SLE-related organ damage are limited. The aim of this study was to evaluate HCRU and costs associated with organ damage in patients with SLE in the USA. Methods This retrospective study (GSK study 208380) used the PharMetrics Plus administrative claims database from 1 January 2008 to 30 June 2019. Patients with SLE and organ damage were identified using International Classification of Diseases (ICD)-9/10 codes derived from the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index. The first observed diagnosis of organ damage was designated as the index date. Selection criteria included: ≥18 years of age; ≥1 inpatient or ≥2 outpatient claims for SLE (≥30 days apart before the index date; ICD-9: 710.0 or ICD-10: M32, excluding M32.0); ≥1 inpatient or ≥3 outpatient claims for organ damage within 6 months for the same organ system code; continuous enrollment of 12 months both pre- and post-index date. The proportion of patients with new organ damage, disease severity, SLE flares, SLE-related medication patterns, HCRU and all-cause costs (2018 US$) were assessed 12 months pre- and post-index date. Results Of the 360,803 patients with a diagnosis of SLE, 8952 patients met the inclusion criteria for the presence of new organ damage. Mean (standard deviation (SD)) age was 46.4 (12.2) years and 92% of patients were female. The most common sites of organ damage were neuropsychiatric (22.0%), ocular (12.9%), and cardiovascular (11.4%). Disease severity and proportion of moderate/severe flare episodes significantly increased from pre- to post-index date (p < 0.0001). Overall, SLE-related medication patterns were similar pre- versus post-index date. Inpatient, emergency department and outpatient claims increased from pre- to post-index date and mean (SD) all-cause costs were 71% higher post- versus pre-index date ($26,998 [57,982] vs $15,746 [29,637], respectively). Conclusions: The economic impact associated with organ damage in patients with SLE is profound and reducing or preventing organ damage will be pivotal in alleviating the burden for patients and healthcare providers.

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Section: Discussionmentioning

confidence: 99%

“…negative impact in physical functioning, health-related quality of life, and life expectancy), 21 , 39 and higher healthcare costs compared with patients with less severe damage. 30 , 40 …”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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An evaluation of costs associated with overall organ damage in patients with systemic lupus erythematosus in the United States

Bell

Ajmera

Meyers

2022

Lupus

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“…This is likely to reflect the extent of organ damage in these patients. Greater organ damage has been associated with increased health-care resource use [ 40 ]. Potentially, cost savings could be achieved by earlier diagnosis and treatment, including careful monitoring, to reduce the onset of irreversible organ damage and the occurrence of co-morbidities.…”

Section: Discussionmentioning

confidence: 99%

Health-care utilization and costs in adults with systemic lupus erythematosus in the United Kingdom: a real-world observational retrospective cohort analysis

Samnaliev¹,

Barut

Weir³

et al. 2021

Rheumatology Advances in Practice

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Objectives To describe direct healthcare costs for adults with systemic lupus erythematosus (SLE) in the UK over time and by disease severity and encounter type. Methods Patients aged ≥18 years with SLE were identified using the linked Clinical Practice Research Datalink—Hospital Episode Statistics database from January 2005 to December 2017. Patients were classified as having mild, moderate, or severe disease using an adapted claims-based algorithm based on prescriptions and comorbid conditions. We estimated all-cause healthcare costs and incremental costs associated with each year of follow-up compared with a baseline year adjusting for age, sex, disease severity, and comorbid conditions (2017 UK pounds). Results We identified 802 patients; 369 (46.0%) with mild, 345 (43.0%) moderate, and 88 (11.0%) severe disease. The mean all-cause cost increased in the 3 years before diagnosis, peaked in the first year after diagnosis and remained high. Adjusted total mean annual increase in costs per patient was £4476 (95% confidence interval £3809–5143) greater in the year of diagnosis compared with the baseline year (p < 0.0001). The increase in costs per year were 4.7-fold and 1.6-fold higher among patients with severe SLE compared with those with mild and moderate SLE respectively. Primary care utilisation was the leading component of costs during the first year of diagnosis. Conclusion The healthcare costs for patients with SLE in the UK are substantial, remain high after diagnosis and increase with increasing severity. Future research should assess whether earlier diagnosis and treatment may reduce disease severity and associated high healthcare costs.

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“…Most commonly, these hospitalizations are related to active SLE (1–5), treatment complications (1–6), or comorbidities (7). Hospitalizations are a major source of direct and indirect costs in SLE (6,8–13) and correlate with increased mortality (4). While hospitalization rates, length of admission, in‐hospital mortality rates, and reasons for hospitalization have been well‐documented in prior SLE studies (1–3,5,6,14), our understanding of the patient characteristics associated with hospitalizations in SLE remains incomplete (1,4,5,15,16).…”

Section: Introductionmentioning

confidence: 99%

Prediction of Hospitalizations in Systemic Lupus Erythematosus Using the Systemic Lupus International Collaborating Clinics Frailty Index

Legge

Kirkland

Rockwood

et al. 2022

Arthritis Care & Research

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Objective The Systemic Lupus International Collaborating Clinics (SLICC) frailty index (FI) predicts mortality and damage accrual in systemic lupus erythematosus (SLE), but its association with hospitalizations has not been described. Our objective was to estimate the association of baseline SLICC‐FI values with future hospitalizations in the SLICC inception cohort. Methods Baseline SLICC‐FI scores were calculated. The number and duration of inpatient hospitalizations during follow‐up were recorded. Negative binomial regression was used to estimate the association between baseline SLICC‐FI values and the rate of hospitalizations per patient‐year of follow‐up. Linear regression was used to estimate the association of baseline SLICC‐FI scores with the proportion of follow‐up time spent in the hospital. Multivariable models were adjusted for relevant baseline characteristics. Results The 1,549 patients with SLE eligible for this analysis were mostly female (88.7%), with a mean ± SD age of 35.7 ± 13.3 years and a median disease duration of 1.2 years (interquartile range 0.9–1.5) at baseline. Mean ± SD baseline SLICC‐FI was 0.17 ± 0.08. During mean ± SD follow‐up of 7.2 ± 3.7 years, 614 patients (39.6%) experienced 1,570 hospitalizations. Higher baseline SLICC‐FI values (per 0.05 increment) were associated with more frequent hospitalizations during follow‐up, with an incidence rate ratio of 1.21 (95% confidence interval [95% CI] 1.13–1.30) after adjustment for baseline age, sex, glucocorticoid use, immunosuppressive use, ethnicity/location, SLE Disease Activity Index 2000 score, SLICC/American College of Rheumatology Damage Index score, and disease duration. Among patients with ≥1 hospitalization, higher baseline SLICC‐FI values predicted a greater proportion of follow‐up time spent hospitalized (relative rate 1.09 [95% CI 1.02–1.16]). Conclusion The SLICC‐FI predicts future hospitalizations among incident SLE patients, further supporting the SLICC‐FI as a valid health measure in SLE.

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Economic Evaluation of Damage Accrual in an International Systemic Lupus Erythematosus Inception Cohort Using a Multistate Model Approach

Cited by 28 publications

References 39 publications

An evaluation of costs associated with overall organ damage in patients with systemic lupus erythematosus in the United States

An evaluation of costs associated with overall organ damage in patients with systemic lupus erythematosus in the United States

Health-care utilization and costs in adults with systemic lupus erythematosus in the United Kingdom: a real-world observational retrospective cohort analysis

Prediction of Hospitalizations in Systemic Lupus Erythematosus Using the Systemic Lupus International Collaborating Clinics Frailty Index

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