Lupus Low Disease Activity State and Reduced Direct Health Care Costs in Patients With Systemic Lupus Erythematosus

Abstract

Objective Treat‐to‐target end points for systemic lupus erythematosus (SLE) have been assessed for their impact on damage accrual and flare, but whether they have an impact on the high health care utilization and costs in SLE has not been studied. The purpose of this study was to examine our hypothesis that the recently described lupus low disease activity state (LLDAS) would be associated with reduced health care cost. Methods Data from a single tertiary hospital longitudinal SLE cohort were assessed. Baseline demographics, disease activity (Systemic Lupus Erythematosus Disease Activity Index 2000 [SLEDAI‐2K], physician global assessment [PhGA], and flare index), and medication use were evaluated, and direct health care utilization and cost data were obtained from hospital information systems. LLDAS was defined as previously published: briefly, SLEDAI‐2K ≤4 with no new activity, PhGA ≤1, prednisolone ≤7.5 mg/day, and optimal standard immunosuppressive agents. Analysis was performed using multivariable linear regression. Results Two hundred SLE patients, contributing 357.8 person‐years of observation, were included. A history of lupus nephritis was present in 42% of patients, and damage (Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index >0) was present at study commencement in 57.3% of patients. The mean ± SD annual direct medical cost per patient was US$7,413 ± 13,133/year. In multivariable analysis, increased cost was associated with the presence of baseline organ damage (41.7% increase; P = 0.009) and corticosteroid use (>7.5–15 mg/day: 55.7% increase; P = 0.02; and >15 mg/day: 202% increase; P < 0.001). In contrast, spending ≥50% of the observation period in LLDAS was associated with a 25.9% reduction in annual direct medical cost (P = 0.04). Conclusion Greater time spent in LLDAS was associated with significantly reduced direct hospital health care costs among patients with SLE.

Achieving remission or low disease activity is associated with better outcomes in patients with systemic lupus erythematosus: a systematic literature review

“…44 Finally, remission and LDA could reduce hospitalisation rate; this has been reported in the Peruvian Almenara Lupus cohort 28 ; LDA could also reduce annual medical cost as reported in a study from an Australian cohort. 41 It is important to point out that this information needs to be confirmed in other populations.…”

Healthcare Utilization and Costs of Systemic Lupus Erythematosus by Disease Severity in the United States

“…Disease progression is associated with multiorgan involvement, including the central 9 . Greater disease severity in related disorders, such as rheumatoid arthritis, has also been associated with greater medical costs 15 , and spending ≥ 50% of the time in a low disease activity state has been associated with a 25.9% reduction in annual direct medical costs for patients with SLE 16 . Over the study period from 2012 to 2015, annual total healthcare costs generally remained the same.…”

Long-term outcomes in systemic lupus erythematosus: trends over time and major contributors

“…Several studies have shown that the risk of damage decreases with the length of time in either LLDAS or remission. While low disease activity intuitively appears to be a less desirable outcome than remission, patients in the LLDAS nevertheless achieve significantly better scores on both the SLE Quality of Life questionnaire and the 36-item Short Form Health Survey [ 76 ], reduced direct healthcare costs [ 77 ], damage and mortality than those with active disease [ 78 ]. Importantly, patients who spent even a short time in clinical remission (even <25% of visits) had a significant decrease in the rate of damage compared with never achieving remission.…”