Healthcare Utilization and Costs of Systemic Lupus Erythematosus in Medicaid

Kan, Hong; Song, Xue; Johnson, Barbara H.; Bechtel, Benno; O'Sullivan, Donna; Molta, Charles

doi:10.1155/2013/808391

Cited by 76 publications

(112 citation statements)

References 14 publications

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“…Given the humanistic and economic burden of SLE (42, 43), addressing immune dysregulation prior to disease classification may prove beneficial (44). Although a therapeutic challenge (45), this study reveals inflammatory and regulatory mechanisms that may be applied to the development of novel SLE therapies (46).…”

Section: Discussionmentioning

confidence: 99%

Discerning Risk of Disease Transition in Relatives of Systemic Lupus Erythematosus Patients Utilizing Soluble Mediators and Clinical Features

Munroe

Young

Kamen

et al. 2017

Arthritis & Rheumatology

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Objective Systemic lupus erythematosus (SLE) and other autoimmune diseases cause significant morbidity. Identifying populations at risk of developing SLE is essential to curtail irreversible inflammatory damage. The objective of this study was to identify factors associated with transition to classified disease that inform SLE risk. Methods Previously identified lupus patient blood relatives with < 4 American College of Rheumatology SLE classification criteria at baseline (n=409) were enrolled in this follow-up study. Participants provided detailed family, demographic, and clinical information, including the SLE-specific portion of the Connective Tissue Disease Screening Questionnaire (SLE-CSQ). Plasma samples were tested for the presence of lupus-associated autoantibodies and 52 soluble mediators. Generalized estimating equations (GEE) were applied to identify factors anticipating disease transition. Results Forty-five relatives (11%) transitioned to classified SLE during follow-up (mean time=6.4 years). Relatives who transitioned displayed more lupus-associated autoantibody specificities and higher SLE-CSQ scores (p<0.0001) at baseline than non-transitioned relatives. Importantly, they also had elevated baseline plasma levels of inflammatory mediators, including B-lymphocyte stimulator (BLyS), stem cell factor (SCF), and interferon-associated chemokines (p≤0.02), with concurrent decreases in levels of regulatory mediators, tumor growth factor (TGF)-β and interleukin (IL)-10 (p≤0.03). GEE revealed that baseline SLE-CSQ or ACR scores and plasma levels of SCF and TGF-β (p≤0.03), but not autoantibodies, were significant and independent predictors of SLE transition. Conclusions Altered levels of soluble mediators anticipate transition to classified disease in lupus relatives. Thus, immune perturbations precede SLE classification and can help identify high-risk relatives for rheumatology referral and potential enrollment in prevention trials.

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Section: Discussionmentioning

confidence: 99%

Discerning Risk of Disease Transition in Relatives of Systemic Lupus Erythematosus Patients Utilizing Soluble Mediators and Clinical Features

Munroe

Young

Kamen

et al. 2017

Arthritis & Rheumatology

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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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“…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).…”

Section: Introductionmentioning

confidence: 99%

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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Healthcare Utilization and Costs of Systemic Lupus Erythematosus in Medicaid

Cited by 76 publications

References 14 publications

Discerning Risk of Disease Transition in Relatives of Systemic Lupus Erythematosus Patients Utilizing Soluble Mediators and Clinical Features

Discerning Risk of Disease Transition in Relatives of Systemic Lupus Erythematosus Patients Utilizing Soluble Mediators and Clinical Features

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

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

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