Economic Evaluation of Damage Accrual in the Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort

Ann E. Clarke¹, Ian N. Bruce², Murray Urowitz³, John G. Hanly⁴, Yvan St.Pierre⁵, Sang-Cheol Bae⁶, Sasha Bernatsky⁷, Dafna D Gladman⁸, Jorge Sanchez-Guerrero⁹, Paul R. Fortin¹⁰, Juanita Romero-Diaz¹¹, Michelle Petri¹², Rosalind Ramsey-Goldman¹³, Cynthia Aranow¹⁴, Søren Jacobsen¹⁵, Daniel J. Wallace¹⁶, Joan T. Merrill¹⁷, S. Sam Lim¹⁸, Ola Nived¹⁹, Andreas Jönsen²⁰, Susan Manzi²¹, Thomas Stoll²², Christine A. Peschken²³, David A. Isenberg²⁴, Anisur Rahman²⁵, Li Su²⁶ and Vernon Farewell²⁷, ¹Division of Rheumatology, University of Calgary, Calgary, 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, ³Centre for Prognosis Studies in the Rheumatic Diseases, University of Toronto, Toronto Western Hospital, Toronto, ON, Canada, ⁴Rheumatology, Division of Rheumatology, Capital Health and Dalhousie University, Halifax, NS, Canada, ⁵McGill University Health Centre, Montreal, QC, Canada, ⁶Department of Rhematology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea, Republic of (South), ⁷Divisions of Rheumatology and Clinical Epidemiology, Research Institute of the McGill University Health Centre, Montreal, QC, Canada, ⁸Centre for Prongosis Studies in The Rheumatic Diseases, University of Toronto, Toronto Western Hospital, Toronto, ON, Canada, ⁹Division of Rheumatology, Toronto Western Hospital, Toronto, AB, Canada, ¹⁰Medicine, CHU de Quebec - Universite de Laval, Quebec, QC, Canada, ¹¹Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico city, Mexico, ¹²Medicine (Rheumatology), Division of Rheumatology, Johns Hopkins University School of Medicine, MD, USA, Baltimore, MD, ¹³FSM, Northwestern University, Chicago, IL, ¹⁴Autoimmune and Musculoskeletal Disease, The Feinstein Institute for Medical Research, Manhasset, NY, ¹⁵Rheumatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark, ¹⁶Rheumatology, Cedars-Sinai Medical Center, Beverly Hills, CA, ¹⁷Oklahoma Medical Research Foundation, Oklahoma City, OK, ¹⁸Division of Rheumatology, Emory University School of Medicine, Atlanta, GA, ¹⁹Department of Rheumatology, University Hospital, Lund, Sweden, ²⁰Lund University, Department of Clinical Sciences, Rheumatology, Lund, Sweden, ²¹Medicine, Allegheny Health Network, Pittsburgh, PA, ²²Abteilung Rheumatologie/Rehab, Kantonsspital Schaffhausen, Schaffhausen, Switzerland, ²³RR 149G, Univ of Manitoba, Winnipeg, MB, Canada, ²⁴Centre for Rheumatology, Division of Medicine, University College London, London, United Kingdom, ²⁵Rayne Institute, Centre for Rheumatology Research, UCL Division of Medicine, London, United Kingdom, ²⁶Nova Scotia Rehab Site, Division of Rheumatology, Capital Health and Dalhousie University, Halifax, NS, Canada, ²⁷Medicine, Division of Rheumatology, Capital Health and Dalhousie University, Halifax, NS, Canada

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: SLE and economics

Session Information

Date: Wednesday, November 8, 2017

Title: Systemic Lupus Erythematosus – Clinical Aspects and Treatment V: Longterm Outcomes

Session Type: ACR Concurrent Abstract Session

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

Background/Purpose:

Little is known about the association of healthcare costs and damage accrual. We describe the costs associated with damage progression using multi-state modeling.

Methods:

Patients fulfilling the revised ACR Criteria for SLE from 32 centres in 11 countries were enrolled in the SLICC Inception Cohort within 15 months of diagnosis. To supplement the primary data collection, patients were sampled cross-sectionally at a single time between 4 and 17 years of disease duration on healthcare use and lost labour force/non-labour force productivity over the preceding year. Healthcare use was costed using 2017 Canadian prices (direct costs) and lost productivity using 2017 Statistics Canada age-sex specific wages (indirect costs). Annual costs associated with damage states (SLICC/ACR Damage Index [SDI]) were estimated from multiple regressions adjusting for age, sex, race/ethnicity, and disease duration. Five and 10-year cumulative costs were estimated by multiplying annual costs associated with each SDI state by the expected duration in each state, forecasted using a multi-state model and longitudinal SDI data from the SLICC Inception Cohort (Bruce IN. Ann Rheum Dis 2015;74:1706-13). Future costs were discounted at a yearly rate of 3%.

Results:

457 patients participated, 88.2% female, 44.6% Caucasian, mean age at diagnosis 33.6 years, mean disease duration at time of the economic data 10.0 years, mean SLE Disease Activity Index (SLEDAI-2K) 2.97, and mean SDI 1.07. Annual direct costs were higher in those with an SDI ≥5 (Table 1). At SDI ≥2, hospitalizations and medications accounted for 54.3% of direct costs, whereas at SDI ≥3, dialysis was responsible for 55.6%.

Table 1. Predicted Annual Health Costs Stratified by SDI

SDI State	Direct Costs, Mean, 95% CI 2017 Canadian $	Indirect Costs, Mean, 95% CI 2017 Canadian $	Total Costs, Mean, 95% CI 2017 Canadian $
0	4642 (3187, 6098)	22611 (16130, 29091)	27253 (20394, 34112)
1	5937 (4472, 7401)	28 934 (22358, 35509)	34870 (27911, 41830)
2	5895 (3763, 8027)	30 573 (21 839, 39 307)	36 468 (27223, 45713)
3	9074 (5387, 12760)	26 743 (12937, 40549)	35 817 (21204, 50429)
4	4241 (0, 9825)	24197 (3364, 45029)	28437 (6387, 50488)
≥5	20014 (14270, 25757)	26758 (6481, 47035)	46771 (25310, 68233)

Cumulative 5 and 10-year direct costs increased with increasing baseline SDI (Table 2). Indirect costs did not vary with baseline SDI.

Table 2. Predicted 5 and 10- Year Cumulative Costs Stratified by Baseline SDI

SDI

Total 5-Year Cumulative Costs,

Mean, 95% CI

2017 Canadian $

Total 10-Year Cumulative Costs,

Mean, 95% CI

2017 Canadian $

Direct

Indirect

Total

Direct

Indirect

Total

23014

(15922, 30106)

118083

(84236, 151931)

141098

(105272, 176923)

45549

(31029, 60068)

238065

(161553, 314576)

283613

(202630, 364597)

29434

(20395, 38472)

143253

(104234, 182272)

172686

(131387, 213986)

61424

(39899, 82950)

274971

(181024, 368917)

336395

(236958, 435833)

33649

(19783, 47516)

142868

(88570, 197166)

176517

(119046, 233989)

75517

(44288, 106746)

270510

(147910, 393110)

346027

(216261, 475792)

44852

(24207, 65497)

130030

(53562, 206499)

174882

(93945, 255820)

100586

(58762, 142410)

254129

(99239, 409019)

354715 (190773, 518657)

55181

(28482, 81879)

126324

(30008, 222641)

181505

(79559, 283451)

129205

(79209, 179201)

251643

(72801, 430485)

380848

(191554, 570143)

≥ 5

94406

(67311, 121501)

132694

(38272, 227116)

227100

(127160, 327040)

175841

(125374, 226308)

259216

(83209, 435224)

435057

(248763, 621352)

Conclusion:

Patients with the highest baseline SDIs incurred cumulative 5 and 10-year direct costs approximately 4-fold higher than those with the lowest SDIs. However, indirect costs were influenced by factors other than SDI (potentially disease activity, quality of life, fatigue, plateauing of expectations regarding productivity later in the disease) and patients incurred considerable indirect costs even with no or minimal damage. This work demonstrates the substantial increase in direct costs in patients with higher damage, highlighting the cost savings potentially achieved by earlier introduction of therapies more effective at attenuating damage progression.

Disclosure: A. E. Clarke, UCB, 2; I. N. Bruce, UCB, 2; M. Urowitz, UCB, 2; J. G. Hanly, None; Y. St.Pierre, None; S. C. Bae, None; S. Bernatsky, None; D. D. Gladman, None; J. Sanchez-Guerrero, None; P. R. Fortin, None; J. Romero-Diaz, None; M. Petri, UCB, 5; R. Ramsey-Goldman, None; C. Aranow, UCB, 2; S. Jacobsen, None; D. J. Wallace, None; J. T. Merrill, UCB, 5; S. S. Lim, None; O. Nived, None; A. Jönsen, None; S. Manzi, None; T. Stoll, None; C. A. Peschken, None; D. A. Isenberg, None; A. Rahman, None; L. Su, None; V. Farewell, None.

To cite this abstract in AMA style:

Clarke AE, Bruce IN, Urowitz M, Hanly JG, St.Pierre Y, Bae SC, Bernatsky S, Gladman DD, Sanchez-Guerrero J, Fortin PR, Romero-Diaz J, Petri M, Ramsey-Goldman R, Aranow C, Jacobsen S, Wallace DJ, Merrill JT, Lim SS, Nived O, Jönsen A, Manzi S, Stoll T, Peschken CA, Isenberg DA, Rahman A, Su L, Farewell V. Economic Evaluation of Damage Accrual in the Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/economic-evaluation-of-damage-accrual-in-the-systemic-lupus-international-collaborating-clinics-slicc-inception-cohort/. Accessed .

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