The Economic Burden of Lupus Nephritis: A Systematic Literature Review

Thompson, Juliette C; Mahajan, Anadi; Scott, David A.; Gairy, Kerry

doi:10.1007/s40744-021-00368-y

Cited by 22 publications

(14 citation statements)

References 60 publications

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“…Supporting the ndings of the current study, previous studies have reported increased HCRU and healthcare costs in patients with SLE with LN compared with patients without LN or matched controls [22][23][24][25][26][27]. Furthermore, Clarke et al compared annual direct medical costs of patients with varying degrees of renal damage and demonstrated that costs elevated with increasing degrees of renal damage [32].…”

Section: Discussionsupporting

confidence: 82%

“…3). This difference was mainly driven by the cost of inpatient admissions, for which the mean (SD) costs were $21,181 (58,886) in Year 1 and lower in subsequent years (Year 2: $7,406 [23,331]; Year 3: $8,197 [24,110]; Year 4: $8,555 [27,403]…”

Section: Sle Aresmentioning

confidence: 99%

“…HCRU and healthcare costs are also higher in patients with LN compared with patients with SLE without LN, or controls, [22][23][24][25][26][27] with medical costs speci c to LN reportedly accounting for approximately 41% of total medical costs in patients with SLE [28]. Despite the high burden of LN in patients with SLE, there are limited data on HCRU and healthcare costs among patients with LN over time.…”

Section: Introductionmentioning

confidence: 99%

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WITHDRAWN: Healthcare Resource Utilization and Costs in Patients With a Newly Confirmed Diagnosis of Lupus Nephritis in the United States Over a 5-year Follow-up Period

Bell

Huang

et al. 2022

Preprint

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Background: Evaluate healthcare resource utilization (HCRU) and healthcare costs in patients with a newly confirmed diagnosis of lupus nephritis (LN) in the United States, over a 5-year follow-up period. Methods: This retrospective, longitudinal cohort study (GSK Study 214102) utilized administrative claims data to identify individuals with a newly confirmed diagnosis of LN between August 1, 2011, and July 31, 2018, based on LN-specific International Classification of Diseases diagnosis codes. Index was the date of first claim with an LN-related diagnosis code during this period. HCRU, healthcare costs, and incidence of systemic lupus erythematosus (SLE) flares were reported for each post-index year of follow-up for eligible patients with at least 5 years continuous enrollment post-index. Results: Of 2,159 patients with a newly confirmed diagnosis of LN meeting inclusion and exclusion criteria, 335 had at least 5 years continuous enrollment post-index. HCRU was greatest in the first year post-LN diagnosis across all categories (inpatient admission, emergency room [ER] visits, ambulatory visits, and pharmacy use), and trended lower, though remained substantial, in the 5-year follow-up period. Among patients with HCRU, the mean (standard deviation [SD]) number of ER visits and inpatient admissions were 3.7 (4.6) and 1.8 (1.5), respectively, in Year 1, which generally remained stable in Years 2–5; the mean (SD) number of ambulatory visits and pharmacy fills were 35.8 (25.1) and 62.9 (43.8), respectively, in Year 1, and remained similar for Years 2–5. Most patients (≥91.6%) had ≥1 SLE flare in each of the 5 years of follow-up. The proportion of patients who experienced a severe SLE flare was higher in Year 1 (31.6%) than subsequent years (14.3%–18.5%). Total costs (medical and pharmacy; mean [SD]) were higher in Year 1 ($44,205 [71,532]) than subsequent years ($29,444 [52,310]–$32,222 [58,216]), driven mainly by inpatient admissions (Year 1: $21,181 [58,886]; subsequent years: $7,406 [23,331]–$9,389 [29,283]). Conclusion: Patients with a newly confirmed diagnosis of LN have substantial HCRU and healthcare costs, particularly in the year post-diagnosis, and largely driven by inpatient costs. This highlights the need for interventions to prevent renal damage and improve outcomes in patients with renal involvement.

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Section: Discussionsupporting

confidence: 82%

Section: Sle Aresmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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WITHDRAWN: Healthcare Resource Utilization and Costs in Patients With a Newly Confirmed Diagnosis of Lupus Nephritis in the United States Over a 5-year Follow-up Period

Bell

Huang

et al. 2022

Preprint

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“…3,5 Despite this, SLRs reporting the impact of LN on HRQoL, fatigue, and health utilities are limited. Although some SLRs have focused on the management and economic burden of LN, [44][45][46][47] there is a need for more SLRs that are focused on the humanistic burden. Therefore, this SLR was carried out to assess the impact of LN on HRQoL, fatigue, and health utilities in this specific subpopulation of patients with SLE.…”

Section: Discussionmentioning

confidence: 99%

Health-related quality of life, fatigue and health utilities in lupus nephritis: A systematic literature review

Kharawala¹,

Kaur²,

Shukla³

et al. 2022

Lupus

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Background Systemic lupus erythematosus (SLE) is a chronic, autoimmune disease characterized by abnormal B-cell activation and the presence of autoantibodies, which can result in organ damage. Lupus nephritis (LN) is the most common severe organ manifestation of SLE and may result in impaired kidney function. However, there is limited research on the health-related quality of life (HRQoL) burden amongst patients with LN. The objective of this systematic literature review was to assess the HRQoL, fatigue and health utilities associated with LN. Methods A structured literature search (GSK Study 212980) of the MEDLINE and Embase databases was conducted in July 2019 and updated September 2021. Relevant international congress abstracts from 2016 to 2021 were searched, and gray literature searches and keyword-based searches in PubMed, Google, and Google Scholar were also conducted. Results were screened according to predefined criteria and data on the outcomes of interest were extracted. A quantitative analysis was conducted to supplement the narrative review, to provide 36-item Short Form survey (SF-36) estimates, and to determine variation by prognostic factors. Results Of 1155 articles identified, 26 studies for a total of 3440 patients were included. Patients with LN showed poorer HRQoL and more fatigue than healthy controls/the general population, although these were similar between patients with SLE with and without LN. HRQoL was worse in patients with LN Class III/IV or with active disease. Fatigue was generally reported as the most burdensome symptom and was associated with lower HRQoL and increased treatment dissatisfaction. During induction treatment, HRQoL and fatigue were improved with mycophenolate mofetil versus cyclophosphamide. HRQoL improved over time with treatment amongst patients with active LN. Very limited data were identified assigning utilities to health states for cost-effectiveness analysis. Nine studies were considered for quantitative analysis of baseline SF-36 scores. The analysis suggested that LN has a significant impact across all SF-36 domains, with the lowest scores in the general health perceptions and role-physical domains and physical component summary. Conclusions There is a large HRQoL burden in patients with LN, in particular regarding symptoms of fatigue. Future research should focus on investigating fatigue severity and health utilities in LN.

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“…Несвоевременная диагностика и неадекватная терапия ВН являются факторами риска развития терминальной стадии почечной недостаточности и смерти [3,4]. Вместе с тем развитие ВН сопряжено со значительно более высокими прямыми и косвенными финансовыми затратами, чем СКВ без поражения почек [5]. ВН наблюдается при остром течении СКВ, чаще у пациентов с дебютом заболевания в детском и/или подростковом возрасте.…”

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Lupus nephritis as a specific clinical and immunological phenotype of systemic lupus erythematosus

Асеева¹,

Лила

Soloviev

et al. 2022

Sovremennaâ revmatologiâ

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Lupus nephritis (LN) is the leading cause of death in systemic lupus erythematosus (SLE), so its early detection and treatment is of utmost importance. Features of the onset, clinical signs, certain morphological classes, as well as more aggressive therapy make it possible to assign SLE with LN to a distinct disease phenotype.Objective: to characterize the clinical, immunological and morphological features of the SLE phenotype with a predominant kidney involvement based on a comparative analysis of patients with LN and without LN.Patients and methods. The study included 400 patients with SLE who met the 2012 SLICC criteria and were hospitalized to V.A. Nasonova Research Institute of Rheumatology from 2013 to 2021. The diagnosis of LN was established in 192 (48%) patients, of which in 82 (43%) it was confirmed by pathological study of kidney biopsy specimens (the SLE group with LN). In 208 (52%) patients, no kidney damage was observed, and they constituted the SLE group without LN.All patients underwent a standard examination with an assessment of disease activity according to the SLEDAI-2K index, irreversible changes in organs according to the SLICC damage index, immunological disorders, clinical and biochemical blood tests, urinalysis according to unified methods, glomerular filtration rate, as well as pathological examination of kidney biopsy specimens for confirmation of LN in the presence of an appropriate clinical picture. In patients of both groups, a comparative study of the main clinical, laboratory, immunological manifestations of SLE, the features of the disease onset, its first clinical signs, possible trigger factors, and the drugs used was carried out.Results and discussion. In the LN group, insolation was more likely to trigger the development of SLE than in the group without LN (respectively, in 26% and 13% of cases; p=0.007). In turn, SLE without kidney damage more often than SLE with LN debuted during pregnancy or after childbirth.The first signs of the disease in almost 40% of patients with LN were proteinuria and/or changes in urinary sediment, edema, increased blood pressure, the development of LN in some cases was preceded by polyarthritis or combined lesions of the skin and joints, but no later than 6 months, signs of kidney damage appeared. In the SLE group without LN, polyarthritis (in 33%), combined lesions of the skin and joints (in 26%), and Raynaud's syndrome (in 16%; p <0.0001) were more often observed at the onset. In patients with LN, erythematous lesions of the facial skin ("butterfly", in 42%), serositis (exudative pleuritis — in 44%, pericarditis — in 46%, ascites and hydrothorax — in 5%; p<0.0001), as well as hematological disorders such as anemia (in 63%), leukopenia (in 49%) and thrombocytopenia (in 42%) were present more frequently. With the development of LN, an acute course and high activity of the disease occurred significantly more often. In the study of immunological parameters in the group without LN, lupus anticoagulant (in 6%) and antibodies to SS-A/Ro and SS-B/La (in 18 and 9% of patients, respectively) were detected significantly more often, while in the LN group — hypocomplementemia (in 81%; p<0.0001). Therapy also differed significantly: patients with LN received higher doses of glucocorticoids (p<0.0001), mycophenolate mofetil, and cyclophosphamide.Conclusion. SLE with LN can be considered a distinct disease phenotype with a set of characteristics (clinical and laboratory parameters, response to therapy, prognosis) that distinguish it from other SLE variants.

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The Economic Burden of Lupus Nephritis: A Systematic Literature Review

Cited by 22 publications

References 60 publications

WITHDRAWN: Healthcare Resource Utilization and Costs in Patients With a Newly Confirmed Diagnosis of Lupus Nephritis in the United States Over a 5-year Follow-up Period

WITHDRAWN: Healthcare Resource Utilization and Costs in Patients With a Newly Confirmed Diagnosis of Lupus Nephritis in the United States Over a 5-year Follow-up Period

Health-related quality of life, fatigue and health utilities in lupus nephritis: A systematic literature review

Lupus nephritis as a specific clinical and immunological phenotype of systemic lupus erythematosus

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