Background/Purpose:  Systemic Lupus Erythematosus (SLE), a chronic autoimmune disease that can affect multiple organ systems and is associated with high morbidity. Reports estimate that the cost of direct health care for patients with SLE is 3-fold higher than the national capital average. Limited data are available on the cost of in-patient care for SLE patients.

Objective: To calculate the cost of admissions, rate of readmissions and potential cost of readmissions of SLE patients at a large tertiary care center.

Methods:  We conducted a financial analysis of all admissions for systemic lupus erythematosus at the 2 major hospitals affiliated with the University of Rochester of Medical Center between the July 1^st of 2013 and June 30^th of 2014. In-patient care for the 2 hospitals, Strong Memorial Hospital (>750 beds) and Highland Community hospital (> 120 beds) are solely provided by faculty in the Department of Allergy, Immunology and Rheumatology.  The total number of admissions for the diagnosis code 710.0 as primary or secondary diagnosis, regardless of rheumatology consults, was calculated. We also estimated the total cost of admissions based on total charges and the revenue generated. Additionally, we recorded the length of stay for all admissions for SLE. To confirm the findings from the financial data search at the two hospitals, we also analyzed our admission log, maintained for all rheumatology consults received for the fiscal year from July 2013 to June 2014, based on primary diagnosis at time of admission and at discharge.

Results:  The total number of SLE admissions for the year was 274, with a total cost estimated to be between $6,213,812.00 and $ 12, 182,166.00 and accounted for 2576 days of admission for all cases. The cost per admission was therefore between $22,678.15 and $ 44,460.46 and the average of length of stay per admission was calculated to be 9.4 days. The cost represented 25.5% of all rheumatology in-patient care. Moreover, 86 SLE consults recorded in the fiscal year 2014, represented about 19% of all in-patient rheumatology admissions, second only to vasculitis as a cause for admission. Of the 86 patients consulted, 12 (14%) were readmitted on multiple occasions accounting for a total of 26 admissions. Readmissions were between 1 and 5 months in duration and were estimated to cost between $317,494.10 and $622,446.44. The most common reason for readmission among these patients was lupus nephritis followed by lupus flare.

Conclusion:  Hospitalization of patients with SLE is a major driver of health care costs and readmission rates for SLE are high. Development of methods to provide coordinated outpatient care and improve outpatient access and counseling are needed to optimize outcomes and decrease cost of care for these patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/admissions-and-readmissions-of-patients-with-systemic-lupus-erythematosus-is-a-major-cause-of-direct-and-indirect-health-care-costs/