Background/Purpose: Systemic lupus erythematosus (SLE) is associated with high economic burden. This real-world study assessed health care resource utilization (HRU) and costs in a US cohort of patients with newly diagnosed SLE.

Methods: Using linked Truven Health MarketScan^® commercial claims data and IQVIA’s GE Centricity electronic medical record (EMR) database, we identified patients ≥18 years old with SLE diagnosis (index) between January 1, 2005 and December 31, 2014, with no prior SLE or lupus nephritis diagnosis 1 year pre-index, who had ≥1 year of continuous enrollment pre- and post-index date. Disease severity was classified as mild, moderate, or severe over 1 year post diagnosis using claims-based algorithms, which combined SLE diagnosis, disease activities/SLE-related conditions, medications, and health services use,¹ supplemented with EMR. HRU and costs (2017 US$) were reported over 1 year pre and post diagnosis. All-cause costs were evaluated with a generalized linear model, adjusting for demographics, clinical characteristics, Charlson comorbidity index, and pre-index cost.

Results: In total, 2,227 patients with SLE were included in this analysis; 586 (26.3%) with mild, 1,135 (51.0%) with moderate, and 506 (22.7%) with severe SLE. Mean (SD) age was 50.2 (13.0) years, 90.6% female, and 54.4% White. Patients were prescribed corticosteroids (76.1%), hydroxychloroquine (59.7%), methotrexate (14.7%), and biologics (2.7%). 

Patients with moderate/severe SLE had more comorbid disease during the year before SLE diagnosis; 26.5% of severe patients had ≥3 Charlson comorbidities compared with 13.8% moderate and 6.1% mild SLE. Moderate/severe patients also had significantly higher mean per-patient costs 1 year before SLE diagnosis, representing a 1.8- and 3.2-fold increase, respectively, vs mild SLE (mild $12,373 [SD $17,171], moderate $22,559 [SD $33,674], severe $39,261 [SD $72,768]; P< 0.0001).

During the first year after SLE diagnosis, the proportion of patients with ≥1 inpatient stay increased with SLE severity (mild 12.8%, moderate 22.4%, severe 51.2%; P< 0.0001), as did the average hospital stay days (0.47 [SD 1.69], 1.31 [SD 3.69], 5.52 [SD 12.33], respectively; P< 0.0001). Similarly, the proportion of patients with ≥1 ED visit increased with disease severity (mild 26.8%, moderate 41.3%, severe 57.9%; P< 0.0001).

Moderate/severe patients had 2.2- and 5.1-fold higher health care costs, respectively, vs mild SLE (average yearly cost: mild $13,415 [SD $15,707], moderate $29,512 [SD $40,466], severe $68,260 [SD $84,712]; P< 0.0001; Figure). Adjusted cost ratio (95% CI) was 1.81 (1.65, 1.98) for moderate vs mild SLE and 4.24 (3.80, 4.73) for severe vs mild SLE.

Conclusion: Prior to SLE diagnosis, health care costs increase with disease severity. For patients with newly diagnosed moderate/severe SLE, total all-cause health care costs during the first year after diagnosis are significantly higher (4.2- and 1.8-fold increase, respectively) compared with mild SLE. This pattern of increased health care costs is also observed during the year before SLE diagnosis. Earlier diagnosis may ensure better health care outcomes and lower associated costs.

¹ Garris C, et al. J Med Econ. 2013;16:667–677.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/comorbidities-health-care-utilization-and-cost-of-care-in-systematic-lupus-erythematous-increase-with-disease-severity-during-1-year-before-and-after-diagnosis-a-real-world-cohort-study-in-the-unit/