<p>Treatment Patterns and Health Care Costs of Lupus Nephritis in a United States Payer Population</p>

Abstract

Objective: To describe the characteristics, treatment patterns, health care resource utilization (HCRU), and cost of care for members of a large United States (US) health insurance plan with lupus nephritis (LN). Methods: A retrospective observational study was conducted using a health insurance plan database to identify adult members with a diagnosis of LN. Medical and pharmacy claims were used to describe demographics, comorbidities, HCRU, and cost patterns over a 12month follow-up period for each patient, between January 1, 2014, and December 31, 2016. All study variables were examined descriptively. Results: A total of 1039 patients were available for analysis (median age, 47 years; 83% female). The median Charlson Comorbidity Index (CCI) was 3.3. Less than half (41%) of patients received immunosuppressive therapies commonly used to treat LN. Evidence indicated that 58% of the study population were prescribed corticosteroid therapy, in most cases (73%) for more than 60 days. Adverse events known to be associated with corticosteroid therapy were recorded in 58% of patients. Guideline-recommended preventive therapy with hydroxychloroquine was prescribed for 54% of members with LN. Nearly half (47%) of members with LN did not see a nephrologist and more than one-third (36%) did not see a rheumatologist over 1 year of follow-up. Rates of all-cause hospitalization and emergency department (ED) use were 25% and 35%, respectively. The mean all-cause per-member-permonth (PMPM) medical cost for the study population was $2801, with LN-specific costs accounting for $1147 PMPM. Conclusion: Patients with LN who are insured through a large US health plan appeared to underutilize outpatient specialist services and guideline-recommended hydroxychloroquine therapy. Corticosteroid use and adverse events known to be associated with corticosteroids were common in this cohort.

Health care utilization and costs of systemic lupus erythematosus in the United States: A systematic review

“…Our review from January 2000 to June 2020 identified 9224 abstracts for review; 479 full-text articles were selected for full-text review (Figure 1). Overall, 51 articles met selection criteria and captured the desired outcomes: health care utilization (28 articles), 10, drug utilization (20 articles), 11,24,[28][29][30][32][33][34][35]37,38,41,42,[47][48][49][50][51][52][53] adherence (7 articles), 27,49,51,52,[54][55][56] direct costs (20 articles), 10,11,20,22,24,25,[28][29][30][31][32][33][34][35]40,42,43,[57][58][59] and indire...…”

“…Among the 39 longitudinal studies included, the length of follow-up range was 6 months to 10 years, with the earliest study periods beginning in 1987. 10,11,[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][37][38][39][40][41][42][43][44][45]47,48,51,53,[56][57][58][59][60]62,68,69 Across all studies, sample sizes varied from fewer than 100 patients up to 340,000 patients, depending on data source, study period, and study objectives. More than 60% of the articles had study populations that were more than 90% female.…”

“…11,22,24,[28][29][30][33][34][35]37,41,42,44,45,58 Twelve studies used claims that were solely or partially from publicly insured patients. 26,27,31,33,40,42,43,46,47,53,57,59 Nine of the cohort studies matched patients with SLE to control patients. 10,11,25,28,29,31,33,35,39,40,48,[58][59][60] Of six prospective cohort studies, four focused on indirect costs using self-reported data 60,62,68,69 and two examined adherence and/or medical utilization using either selfreported data 56 or the Medication Events Monitoring System.…”

“…10,11,24,30,33,40,42,43,55,58 Patterns of health care utilization Twenty-nine studies evaluated annual health care utilization, by reported ED visits, hospitalizations, or outpatient or clinic visits (Table 2). 10,57 Two studies, Ward et al 46 and Katz et al, 36 were cross-sectional, the remaining were retrospective cohort studies. Although most studies examined claims databases, six used inpatient records or hospital discharge abstracts.…”

“…The most commonly reported mean annual number of hospital stays ranged from 0.1 to 2.4 10,22,24,26,[28][29][30][31][35][36][37]40,42,43 for patients with SLE across studies, with a range of 9%-59% of patients having at least one hospital stay, 10,22,24,[28][29][30][31]37,40,42,43,57 depending on study design, cohort composition, and payer type (Table 2). Patients with lupus nephritis had approximately 0.5 more inpatient stays per year than patients with SLE without lupus nephritis.…”