Background/Purpose: Newer therapeutic agents in systemic lupus erythematosus (SLE) may increase cost of care but their effect on limiting the duration and the dosage of glucocorticoids (GC) use (“steroid sparing”) may reduce costs and improve other outcomes. This study investigated the determinants of healthcare utilization and costs with the use of GC among adult SLE patients (18-64 years old) in the US using a large administrative database.

Methods: This cross-sectional study analyzed insurance claims in 2007-2011 from established SLE patients identified by their ICD-9-CM diagnosis codes. Five patient groups defined by their oral GC use during the one-year study period were studied: non-GC users, <60 day of GC-use, ≥60 days of GC in low-dose (≤7.5mg), medium-dose (>7.5 to ≤15mg), or higher-dose (>15mg). Annual healthcare utilization and costs were compared across these groups and dose-response was examined among users with ≥60 days of GC. Incremental costs of GC groups, calculated as the difference in total healthcare costs compared with non-GC group, were estimated from multivariable regressions adjusting for demographic and clinical characteristics and stratified by immunosuppressant use. Immunosuppressant use as a surrogate for SLE disease severity was stratified to evaluate the potential cost-saving associated with GC-sparing therapies.

Results: A total of 50,230 patients with SLE were identified, including 52% non-GC users, 20% with <60 days of GC use, and 10% low-dose, 10% medium-dose, and 8% higher-dose with ≥60 days of GC use. GC users had higher healthcare utilization and costs (Figure 1). Incremental costs were significant (all p<0.01) for medium-dose ($5,319 - $6,913) and higher-dose ($12,517 - $15,019) GC groups, regardless of other immunosuppressant use (Figure 2). The incremental costs for low-dose GC group with concomitant immunosuppressants ($1,285; p=0.04) were smaller than the incremental costs for low-dose GC group without concomitant immunosuppressants ($2,514; p<0.01).

Conclusion: In this large national sample, any GC use especially at higher dose was associated with higher healthcare utilization and costs in patients with SLE. Therapies with GC-sparing effect that can allow patients to maintain on low GC dose may potentially reduce the healthcare economic burden in the treatment of SLE.