Background/Purpose:  Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease that can affect multiple organ systems and is associated with high morbidity. Studies have shown that there is a substantial health care costs associated with hospitalization of SLE patients. Among chronic, complex disease, often a small percentage of patients account for the majority of health care spending. Objective: To identify if there is a high risk, high cost group of SLE patients among all hospital admissions for SLE over a 2 year period.

Methods:  We conducted a financial analysis of all admissions for systemic lupus erythematosus at the Strong Memorial Hospital between the July 1^st of 2013 and June 30^thof 2015. The total number of admissions for diagnosis code 710.0 was calculated based on primary or secondary diagnosis for the 2 fiscal years. The diagnosis of SLE was confirmed based on the presence of at least 4 criteria or had to be made by a rheumatologist. The age at time of admission and age when diagnosis of SLE was first made, gender, race, reason for admission and the zip code of the primary residence were recorded. Additionally, we noted the number of readmissions within a year and readmission within a 30-day period. We then determined the total cost of admissions, readmission and recorded the length of stay for all admissions and readmissions.

Results:  The total number of confirmed cases of SLE admissions for the 2 years was 387 that comprised 202 patients. Of these 175 (45%) were due to readmissions (within a year) and 113 (29%) were readmissions within a 30 day period. The total cost of all admissions was $10,353,617 for the 2 years while the cost of readmissions was $1,772,675.00 per year. The cost of all readmissions within the 30-day period was $1,182,375 for the 2 year period. The length of stay for all SLE admissions was 1,564 days per year. Approximately, 44% of admitted patients were of American origin with 60% residing within the city of Rochester.Further analysis showed that 28 (16%) of the patients accounted for about 40% of the total cost of all admissions ($3,900,156), 45% of the length of stay, 49% of all admissions and 76% of all 30-day readmissions. These high risk patients were more likely to be younger, have earlier onset of SLE, more likely to be African American and more likely to be from within the city limits. The average cost of hospitalization for the high risk patients was $150,000 compared to $51,808 for other SLE patients. See Table

Conclusion:  Hospitalizations of patients with SLE is a major cause for health care costs and readmission rates for SLE are high. A small group of high risk, high cost patient’s account for majority of the hospitalization costs and length of stay among all SLE patient hospitalizations. A high-riskcare management plan could substantially reduce costs and improve quality of care for these patients.  

AA: African American; C: Caucasian; A: Asian; H: Hispanic; LOS-length of stay

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-small-number-of-patients-with-sle-account-for-most-of-the-direct-and-indirect-hospitalization-costs/