ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 3168

Economic Evaluation of Damage Accrual in an International SLE Inception Cohort

Megan Barber1, Ian N. Bruce2, Murray Urowitz3, John G. Hanly4, Li Su5, Juanita Romero-Diaz6, Caroline Gordon7, Sang-Cheol Bae8, Sasha Bernatsky9, Daniel J Wallace10, Joan T. Merrill11, David A. Isenberg12, Anisur Rahman13, Ellen M. Ginzler14, Michelle Petri15, Mary Anne Dooley16, Paul R. Fortin17, Dafna D. Gladman18, Jorge Sanchez-Guerrero19, Kristján Steinsson20, Rosalind Ramsey-Goldman21, M Khamashta22, Cynthia Aranow23, Graciela S. Alarcon24, Barri J. Fessler25, Susan Manzi26, Ola Nived27, Andreas Jönsen28, Asad Zoma29, Ronald F. van Vollenhoven30, Manuel Ramos-Casals31, Guillermo Ruiz-Irastorza32, S. Sam Lim33, Kenneth C. Kalunian34, Murat Inanc35, Diane L. Kamen36, Christine A. Peschken37, Søren Jacobsen38, Anca Askanase39, Jill P. Buyon40, Chris Theriault41, Vernon Farewell42 and Ann E. Clarke43, 1Division of Rheumatology, University of Calgary, Caglary, AB, Canada, 2Central Manchester University Hospital NHS Foundation Trust and Manchester Academic Health Science Centre, Arthritis Research UK Epidemiology Unit, The University of Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom, 3Medicine, Toronto Western Hospital and University of Toronto, Toronto, ON, Canada, 4Rheumatology, Division of Rheumatology, Capital Health and Dalhousie University, Halifax, NS, Canada, 5Nova Scotia Rehab Site, Division of Rheumatology, Capital Health and Dalhousie University, Halifax, NS, Canada, 6Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico city, Mexico, 7NIHR/Wellcome Trust Clinical Research Facility, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom, 8Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea, Republic of, 9Divisions of Rheumatology and Clinical Epidemiology, McGill University Health Centre, Montreal, QC, Canada, 10Cedars-Sinai Medical Center, West Hollywood, CA, 11Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Oklahoma City, OK, 12Centre for Rheumatology, Division of Medicine, University College London, London, United Kingdom, 13Rayne Institute, Centre for Rheumatology Research, UCL Division of Medicine, London, United Kingdom, 14Rheumatology, SUNY Downstate Medical Center, Brooklyn, NY, 15Rheumatology Division, Johns Hopkins University School of Medicine, Baltimore, MD, 16Dooley Rheumatology, Chapel Hill Doctors, Chapel Hill, NC, 17Rheumatology, University of Laval, Quebec, QC, Canada, 18Rheumatology, Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, ON, Canada, 19Rheumatology, Toronto Western Hospital, Toronto, ON, Canada, 20Rheumatology, Univ. Hospital, Reykjavik, Iceland, 21FSM, Northwestern University, Chicago, IL, 22Lupus Research Unit, Lupus Research Unit, The Rayne Institute, King's College London School of Medicine, St Thomas' Hospital, London, United Kingdom, 23Molecular Medicine and Medicine, Hofstra Northwell School of Medicine, Hempstead, NY, 24Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, 25Rheumatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, 26Lupus Center of Excellence, West Penn Allegheny Health System, Pittsburgh, PA, 27Department of Rheumatology, University Hospital, Lund, Sweden, 28Lund University, Department of Clinical Sciences, Rheumatology, Lund, Sweden, 29Rheumatology, Hairmyres Hospital, East Kilbride, Great Britain, 30Amsterdam Rheumatology and Immunology Center (ARC), Amsterdam, Netherlands, 31Department of Autoimmune Diseases, ICMiD, Hospital Clínic, Sjögren Syndrome Research Group (AGAUR), Laboratory of Autoimmune Diseases Josep Font, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain, 32Universidad del Pais Vasco, Servicio de Medicina Interna, Hospital de Cruces, Bizkaia, Spain, 33Medicine, Emory University School of Medicine, Atlanta, GA, 34Division of Rheumatology, Allergy & Immunology, UCSD School of Medicine Center for Innovative Therapy, La Jolla, CA, 35Department of Internal Medicine, Division of Rheumatology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey, 36Medicine/Rheumatology & Immunology, Medical University of South Carolina, Charleston, SC, 37RR 149G, Univ of Manitoba, Winnipeg, MB, Canada, 38Rheumatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark, 39Rheumatology, Columbia University Medical Center, New York, NY, 40Medicine, New York University School of Medicine, New York, NY, 41Medicine, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, NS, Canada, 42Medicine, Division of Rheumatology, Capital Health and Dalhousie University, Halifax, NS, Canada, 43Division of Rheumatology, University of Calgary, Calgary, AB, Canada

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords:

Session Information

Date: Wednesday, November 16, 2016

Title: Systemic Lupus Erythematosus – Clinical Aspects and Treatment V: Damage and Morbidity

Session Type: ACR Concurrent Abstract Session

Session Time: 9:00AM-10:30AM

Background/Purpose: Little is known about the association of healthcare costs with damage accrual in SLE. We describe the costs associated with damage states across the disease course using multi-state modeling.

Methods: Patients fulfilling the revised ACR classification criteria for SLE from 32 centres in 11 countries were enrolled in the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort within 15 months of diagnosis. Annual data on demographics, SLE disease activity (SLEDAI-2K), damage (SLICC/ACR Damage Index [SDI] if ≥ 6 months from diagnosis), hospitalizations, medications, dialysis, and utilization of selected medical/surgical procedures were collected. Annual health resource utilization was costed using 2015 Canadian prices. Annual costs associated with SDI states were obtained from multiple regressions adjusting for age, race/ethnicity, and disease duration. As there were relatively few transitions to SDI states 5 – 11, these were merged into a single SDI state. Five and 10-year cumulative costs were estimated by multiplying annual costs associated with each SDI state by the expected duration in each state, which was forecasted using a multi-state Markov model (Bruce IN et al. Ann Rheum Dis 2015;74:1706-13).

Results: 1641 patients participated, 89.2% female, 48.9% Caucasian, mean age at diagnosis 35.2 years (SD 13.4), mean disease duration at enrollment 0.5 years (SD 0.3), and mean follow up 6.1 years (range 0.1 – 13.7 years). Health resource utilization and annual costs (after adjustment using regression) were markedly higher in those with higher SDIs (Table 1).

Table 1. Predicted Annual Health Costs Stratified by SDI

SDI State

Health Care Costs, Mean, 95% CI

2015 Canadian $

0

1569 (691,2448)

1

3317 (2234, 4399)

2

4528 (2969, 6086)

3

7422 (5350, 9494)

4

14 631 (8450, 20 813)

≥5

31 692 (20 860, 42 524)

Five and 10-year cumulative costs stratified by baseline SDI were calculated by multiplying the annual costs associated with each SDI by the expected duration in that state (5-year example in Table 2).

Table 2. Expected Duration in each SDI state over 5 Years
Baseline SDI State Expected Duration in each SDI State over 5 years

0

1

2

3

4

≥5

0

4.12 yrs

0.64 yrs

0.18 yrs

0.05 yrs

0.01 yrs

0.002 yrs

1

3.17 yrs

1.28 yrs

0.43 yrs

0.09 yrs

0.03 yrs

2

3.05 yrs

1.42 yrs

0.37 yrs

0.17 yrs

3

3.22 yrs

1.11 yrs

0.67 yrs

4

2.61 yrs

2.39 yrs

≥5

5 yrs

Five and 10-year costs were greater in those with the highest SDIs at baseline (Table 3).

Table 3. Predicted 5 and 10- Year Cumulative Costs Stratified by Baseline SDI

Baseline SDI State

Health Care Costs, Mean, 95% CI

2015 Canadian $

5-Year Cumulative Costs

10-Year Cumulative Costs

0

7440 (2729, 12 151)

16 940 (4548, 29 333)

1

19 301 (11 991, 26 612)

54 122 (31 306, 76 937)

2

32 468 (20 557, 44 379)

92 155 (57 941, 132 368)

3

58 874 (38 022, 79 726)

157 626 (98 830, 216 422)

4

111 379 (68 987, 153 770)

250 293 (155 798, 344 789)

≥5

155 961 (101 449, 210 472)

306 919 (197 091, 416 747)

Conclusion: Patients with the highest baseline SDIs incur annual costs and 10-year cumulative costs that are approximately 20-fold higher than those with the lowest baseline SDI. By estimating the expected duration in each SDI state and incorporating annual costs, disease severity at presentation can be used to predict future healthcare costs, critical knowledge for cost-effectiveness evaluations of novel therapies.

Disclosure: M. Barber, None; I. N. Bruce, UCB, 2; M. Urowitz, UCB, 2; J. G. Hanly, None; L. Su, None; J. Romero-Diaz, None; C. Gordon, None; S. C. Bae, None; S. Bernatsky, None; D. J. Wallace, None; J. T. Merrill, UCB, 5; D. A. Isenberg, None; A. Rahman, None; E. M. Ginzler, None; M. Petri, UCB, 5; M. A. Dooley, None; P. R. Fortin, None; D. D. Gladman, None; J. Sanchez-Guerrero, None; K. Steinsson, None; R. Ramsey-Goldman, None; M. Khamashta, None; C. Aranow, UCB, 2; G. S. Alarcon, None; B. J. Fessler, None; S. Manzi, None; O. Nived, None; A. Jönsen, None; A. Zoma, None; R. F. van Vollenhoven, None; M. Ramos-Casals, None; G. Ruiz-Irastorza, None; S. S. Lim, None; K. C. Kalunian, None; M. Inanc, None; D. L. Kamen, None; C. A. Peschken, None; S. Jacobsen, None; A. Askanase, None; J. P. Buyon, None; C. Theriault, None; V. Farewell, None; A. E. Clarke, UCB, 2.

To cite this abstract in AMA style:

Barber M, Bruce IN, Urowitz M, Hanly JG, Su L, Romero-Diaz J, Gordon C, Bae SC, Bernatsky S, Wallace DJ, Merrill JT, Isenberg DA, Rahman A, Ginzler EM, Petri M, Dooley MA, Fortin PR, Gladman DD, Sanchez-Guerrero J, Steinsson K, Ramsey-Goldman R, Khamashta M, Aranow C, Alarcon GS, Fessler BJ, Manzi S, Nived O, Jönsen A, Zoma A, van Vollenhoven RF, Ramos-Casals M, Ruiz-Irastorza G, Lim SS, Kalunian KC, Inanc M, Kamen DL, Peschken CA, Jacobsen S, Askanase A, Buyon JP, Theriault C, Farewell V, Clarke AE. Economic Evaluation of Damage Accrual in an International SLE Inception Cohort [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/economic-evaluation-of-damage-accrual-in-an-international-sle-inception-cohort/. Accessed .

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