Background/Purpose: Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease that affects multiple organs including the heart, lungs, kidneys, as well as the joints and the nervous system. While the economic burden has been explored for specific organ systems in SLE with high associated morbidity (e.g. renal), less is known about the economic impact of other organ systems associated with SLE, particularly those with less perceived serious morbidity (e.g. musculoskeletal, etc.)  The objective of this analysis was to describe the annual direct medical costs associated with select organ system comorbidities among SLE patients in a commercially-insured population in the United States (U.S).

Methods: This study employed a retrospective, observational design. Adults ages 18-64 years with at least one SLE-related inpatient or emergency department (ED) claim or at least two SLE-related outpatient visits with a rheumatologist at least 30 days apart between 7/1/2004 and 12/31/2008, and continuous medical/prescription coverage for at least 6 months prior and 12 months following the index diagnosis of SLE were identified in the MarketScan Commercial Claims and Encounters database. Select comorbid conditions representing SLE-related major organ/system damage were identified using primary or secondary ICD-9-CM codes and included neuropsychiatric, renal, pulmonary, cardiovascular, musculoskeletal, and mucocutaneous manifestations.  All-cause healthcare utilization and costs were assessed in the follow-up period and reported by type of service (e.g. inpatient, outpatient, pharmacy and total). Total, all-cause healthcare costs, adjusted to 2010 U.S dollars, are reported as annualized rates per patient to account for variable follow-up.  Costs reflect the paid amounts of adjudicated claims and patient co-pays.

Results: 13,460 SLE cases (mean age: 45.6 years; female: 91.6% female) were identified.  Mean length of follow-up was 1,054.6 days (SD: 522.9 days).  During the follow-up period, cardiovascular (49.0%) and musculoskeletal (40.3%) comorbidities were observed most frequently, followed by neuropsychiatric (16.7%), renal (14.2%), mucocutaneous (5.4%) and pulmonary (3.4%) comorbidities. Total annual, mean all-cause costs were $30,369 ± $58,344 in the overall SLE population.  Among patients with evidence of SLE-related organ damage, annual mean costs were highest for pulmonary ($74,433; SD=$97,787) and renal ($65,442; SD=$111,541) comorbidities (all p-values<0.001).   Compared to the overall SLE population, costs were also higher among SLE patients with cardiovascular ($44,066; SD=$75,161), neuropsychiatric ($43,820; SD=$62,646 ), mucocutaneous ($41,841; SD=$104,766), and musculoskeletal ($38,986; SD=$66,986) comorbidities (all p-values<0.001).

Conclusion: As expected, organ system involvement associated with high morbidity were associated with highest annual costs on a per diem basis.  However, other comorbidities such as cardiovascular and musculoskeletal manifestations, also represent a substantial impact to the health care system, particularly given their higher prevalence.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/direct-medical-cost-associated-with-organ-system-involvement-in-a-commercially-insured-population-with-systemic-lupus-erythematosus-in-the-united-states/