Disparities in Utilization and Direct Costs of Hospitalizations and Emergency Room Visits in SLE: The Georgia Lupus Registry

S. Sam Lim¹, Cristina Drenkard¹, Gaobin Bao¹, Jayanti Mukherjee², Sean E. Connolly², Andrew Napoli², Damemarie Paul² and Evo Alemao², ¹Emory University, Atlanta, GA, ²Bristol-Myers Squibb, Princeton, NJ

Meeting: 2018 ACR/ARHP Annual Meeting

Keywords: Lupus and economics

Session Information

Date: Sunday, October 21, 2018

Title: Healthcare Disparities in Rheumatology Poster

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: There is a lack of population-based statistics on utilization and costs of direct healthcare of systemic lupus erythematosus (SLE) in the US, which disproportionately impacts blacks. Data are limited to those from databases, such as Medicaid and commercial claims, which cannot validate SLE diagnoses on a larger scale. To overcome these limitations, we utilized a population-based registry to evaluate healthcare utilization and direct costs in SLE. Methods: The Georgia Lupus Registry is a Centers for Disease Control and Prevention-funded population-based registry of validated SLE patients in Atlanta, GA, from 2002–04. The state privacy exemption for public health surveillance allowed diagnoses to be validated without consent on a population level, using ≥4 ACR criteria or 3 ACR criteria with a final diagnosis of SLE by a board-certified rheumatologist. Validated incident patients were matched with the state Hospital Discharge Database from 2000–13, which captured all hospital and emergency room (ER) admissions. Direct costs were reported according to the latest Medicare reimbursement rates, regardless of insurance or lack thereof. Patients were censored at death. Results: Of 336 incident patients, 86.9% were female, 73.8% black, 22.9% white and 58.9% unmarried; 246 (73.2%) were admitted to hospital and 257 (76.5%) to the ER (Table 1). Patients admitted to the ER and hospital were significantly more likely to be black and have serositis. Hospitalized patients were also more likely to have a renal disorder and meet a greater number of ACR criteria (Table 1). Overall, 1255 hospitalizations had a total cost of $56,365,119 (Table 2). The hospitalization rate was higher in blacks and those with renal disorders. Charges per hospitalization were higher in whites compared with blacks and in those with renal involvement. Length of stay per admission was similar across all groups (6–8 days) (Table 2). There were 2004 ER admissions with a total cost of $4,818,097. The ER admission rate was highest in the blacks and those with renal involvement. Charges per ER admission were similar by sex and in those with renal involvement, but were higher in whites compared with blacks (Table 2).

Conclusion: SLE has significant healthcare utilization and cost burden. A large proportion of patients are admitted to the ER or hospital. Blacks and those with early renal involvement have a higher rate of hospital and ER admissions. Despite having fewer hospital and ER admissions, whites incurred higher charges per admission than blacks. Further study of factors that drive healthcare utilization and cost is needed.

Disclosure: S. S. Lim, None; C. Drenkard, Centers for Disease Control and Prevention (CDC) grant U01DP005119; NIH (R01AR065493-01; R01MD010455-01; R01AR070898-01), 2,Emory University, 3; G. Bao, None; J. Mukherjee, Bristol-Myers Squibb, 1, 3; S. E. Connolly, Bristol-Myers Squibb, 1, 3; A. Napoli, Bristol-Myers Squibb, 1, 3; D. Paul, Bristol-Myers Squibb, 3; E. Alemao, Bristol-Myers Squibb, 1, 3.

To cite this abstract in AMA style:

Lim SS, Drenkard C, Bao G, Mukherjee J, Connolly SE, Napoli A, Paul D, Alemao E. Disparities in Utilization and Direct Costs of Hospitalizations and Emergency Room Visits in SLE: The Georgia Lupus Registry [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/disparities-in-utilization-and-direct-costs-of-hospitalizations-and-emergency-room-visits-in-sle-the-georgia-lupus-registry/. Accessed .

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