Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose: Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease with an unpredictable disease course with sporadic periods of illness (flares). Little is known about how the severity of flares impacts the economic burden of SLE. The aim of the current study was to estimate the economic burden associated with SLE, stratified by flare severity among SLE patients in a commercially-insured population in the United States (U.S).
Methods: In this retrospective, observational study, commercially insured adults (employees or their dependents) ages 18-64 years with at least one SLE-related inpatient or emergency room (ER) claim or at least two SLE-related outpatient visits at least 30 days apart with a rheumatologist between 7/1/2004 and 12/31/2008, and at least 6 months of pre-index and 12 months of post-index continuous medical/prescription coverage were identified in the MarketScan Commercial Claims database. Non-SLE controls were matched to SLE cases using propensity score matching. Mild, moderate, and severe flares were identified in the follow-up period for the SLE patients using a claims-based algorithm and patients were categorized according to their highest degree of flare. A log transformation was applied to the medical expenditures to accommodate specific observed data properties (e.g., skewness). A subsequent linear model was used to adjust for any remaining imbalances from matching and to estimate the incremental annual economic burden (all-cause direct medical cost, in 2010 U.S dollars) associated with SLE for different levels of flare severity for SLE patients in comparison to their matched non-SLE controls.
Results: 13,460 SLE cases (mean age: 45.6 years; 91.6% female; average length of follow-up: 2.9 years) were matched to 13,460 non-SLE controls (mean age: 47.1 years; 88.9% female; average length of follow-up: 2.0 years). During the follow-up period, SLE cases had a significantly higher overall comorbidity burden, (Charlson Comorbidity Index score 1.5, vs. 1.0; p<0.001) and a higher proportion had hospitalizations (49.7% vs. 27.7%; p<0.001) and ER visits (66.7% vs. 43.7%, p<0.001) compared to non-SLE controls. Among SLE cases with no flares, mild/moderate and severe flares as highest flare severity, annualized all-cause direct medical costs were $14,945, $21,606 and $64,578 respectively. In multivariate models comparing non-SLE controls, incremental adjusted annualized direct medical costs for SLE cases with no flares, mild/moderate and severe flares respectively were $441, $3,606 (p<0.05) and $18,953 (p<0.05).
Conclusion: Significantly greater proportions of patients with SLE had a hospitalization or ER visit over a 1-year follow-up than their matched non-SLE counterparts. The direct medical costs of patients with SLE were significantly higher than controls, with costs increasing substantially as the severity of flares increase.
Disclosure:
S. Narayanan,
Human Genome Sciences, Inc. ,
1,
Human Genome Sciences, Inc. ,
3;
E. Durden,
Human Genome Sciences, Inc. and GlaxoSmithKline,
2;
A. Oglesby,
GlaxoSmithKline,
1,
GlaxoSmithKline,
3;
P. Juneau,
Human Genome Sciences, Inc. and GlaxoSmithKline,
2;
K. L. Wilson,
Human Genome Sciences, Inc. and GlaxoSmithKline,
2.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/economic-burden-of-systemic-lupus-erythematosus-by-flare-severity-in-a-commercially-insured-population-in-the-united-states/