ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 0881

Economic Evaluation of Neuropsychiatric (NP) Lupus in an International Inception Cohort Using a Multistate Model Approach

Ann Clarke1, John Hanly2, Yvan St.Pierre3, Caroline Gordon4, Sang-Cheol Bae5, Juanita Romero-Diaz6, Jorge Sanchez-Guerrero7, Sasha Bernatsky8, Daniel Wallace9, David Isenberg10, Anisur Rahman11, Joan Merrill12, Paul R Fortin13, Dafna Gladman14, Murray Urowitz15, Ian N. Bruce16, Michelle Petri17, Ellen Ginzler18, Mary Anne Dooley19, Rosalind Ramsey-Goldman20, Susan Manzi21, Andreas Jnsen22, Graciela Alarcn23, Ronald van Vollenhoven24, Cynthia Aranow25, Meggan Mackay25, Guillermo Ruiz-Irastorza26, S Sam Lim27, Murat Inanc28, Kenneth Kalunian29, Soren Jacobsen30, Christine Peschken31, Diane Kamen32, Anca Askanase33 and Vernon Farewell34, 1University of Calgary, Calgary, AB, Canada, 2Dalhousie University, Halifax, NS, Canada, 3Research Institute of the McGill University Health Centre, Montréal, QC, Canada, 4Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom, 5Hanyang University Medical Center, Seoul, Republic of Korea, 6Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Ciudad de México, Federal District, Mexico, 7Instituto Nacional de Ciencias Médicas y Nutrición, Inmunología y Reumatología, Mexico City, Mexico, 8McGill University, Montréal, QC, Canada, 9Cedars-Sinai, Los Angeles, CA, 10Centre for Rheumatology, University College London, London, United Kingdom, 11University College London, London, United Kingdom, 12Oklahoma Medical Research Foundation, Oklahoma City, OK, 13CHU de Quebec - Universite Laval, Québec City, QC, Canada, 14Schroeder Arthritis Institute, Krembil Research Institute, Toronto Western Hospital, Toronto, ON, Canada, 15Center for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, University of Toronto, Lupus Clinic, Toronto, ON, Canada, 16University of Manchester, Manchester, United Kingdom, 17Johns Hopkins University School of Medicine, Baltimore, MD, 18SUNY Downstate Health Sciences University, Brooklyn, NY, 19Raleigh Neurology Associates, Chapel Hill, NC, 20Northwestern University, Chicago, IL, 21Allegheny Health Network, Wexford, PA, 22Lund University, Lund, Sweden, 23University of Alabama at Birmingham, Birmingham, AL, 24Department of Rheumatology and Clinical Immunology, Amsterdam University Medical Center, Amsterdam Rheumatology Center, Amsterdam, Netherlands, 25Feinstein Institutes for Medical Research, Manhasset, NY, 26Hospital Universitario Cruces, University of the Basque Country, Bizkaia, Spain, 27Department of Medicine, Division of Rheumatology, Emory University School of Medicine, Atlanta, GA, 28Istanbul University Faculty of Medicine, Istanbul, Turkey, 29UC San Diego, La Jolla, CA, 30Rigshospitalet, Copenhagen, Denmark, 31University of Manitoba, Winnipeg, MB, Canada, 32Medical University of South Carolina, Charleston, SC, 33Columbia University Medical Center, New York, NY, 34University of Cambridge, Cambridge, United Kingdom

Meeting: ACR Convergence 2021

Keywords: , ,

Session Information

Date: Sunday, November 7, 2021

Title: SLE – Diagnosis, Manifestations, & Outcomes Poster II: Manifestations (0855–0896)

Session Type: Poster Session B

Session Time: 8:30AM-10:30AM

Background/Purpose: Little is known about the economic burden of NP lupus. We estimated annual and cumulative direct and indirect costs (DC, IC) associated with NP events attributed to SLE and non-SLE causes using multistate modelling in a multicentre, multi-ethnic inception cohort.

Methods: Patients fulfilling revised ACR classification criteria for SLE from 31 centres in 11 countries were enrolled within 15 months of diagnosis. NP events were documented annually using ACR NP case definitions and attributed to either SLE or non-SLE causes. At each assessment and for both SLE and non-SLE events, patients were stratified into 1 of 3 NP states (no, resolved, or new/ongoing NP event). The change in NP status characterized by transition rates between states was analyzed over time, using multistate modelling for SLE attributed NP events and non-SLE attributed NP events (Hanly. A&R 2021; doi: 10.1002/art.41876) (Fig 1).

At each assessment, annual DC and IC were based on health resource use and lost work-force/non-work-force productivity over the preceding year. Resource use was costed using 2021 Canadian prices and lost productivity using Statistics Canada age-and-sex specific wages. Costs associated with each SLE and non-SLE NP state were calculated by averaging all observations in each NP state. Multiple regressions including age at diagnosis, sex, race/ethnicity, disease duration, geographic region, and smoking adjusted for possible confounding of these variables on the association of annual DC and IC and NP state. 5 and 10-year cumulative costs for each NP state were predicted by multiplying adjusted annual costs associated with each state by the expected duration in each state, forecasted using the multistate model.

Results: 1697 patients (89% female, 51% non-Caucasian race/ethnicity, mean age at enrolment 35.1 years) were followed for a mean of 8.8 years. 1971 NP events occurred in 956 patients, 32% attributed to SLE. Across 13,987 assessments, the majority of observations were provided by patients with no NP event (Table 1.) For the SLE NP events, annual DC were higher in those with a new/ongoing vs no event ($10809 vs $6715) (Table 2). Although 5 and 10-yr cumulative DC trended higher in the new/ongoing vs no event, the differences were not significant. However, annual and 5-yr IC were higher in the new/ongoing vs no event and new/ongoing vs resolved event. (5-yr: new/ongoing vs no: $172674 vs $ $136970). For the non-SLE NP events, although all DC trended higher in the new/ongoing vs no event, the differences were not significant. However, annual IC were higher in the new/ongoing vs no event, new/ongoing vs resolved event, and resolved vs no event and 5 and 10-yr IC were higher in the new/ongoing vs no event (10-yr: new/ongoing vs no: $342434 vs $279874). For all NP states, IC exceeded DC between 2.8 and 4-fold.

Conclusion: IC are approximately 1.3-fold higher in patients with new/ongoing vs no NP events, attributed to either SLE or non-SLE. While DC trended higher in those with new/ongoing events, they did not differ significantly. Impaired productivity associated with both ongoing and resolved NP lupus is substantial and underscores the previously documented reduced quality of life in NP lupus.

Figure 1: Reversible Multistate Patient Level Models for Observed Transitions* in a) SLE NP Events and b) Non-SLE NP Events

Table 1: Observed Annual Unadjusted Costs (in 2021 Canadian dollars), Stratified by a) SLE NP State and b) Non-SLE NP State

Table 2: Predicted Annual and 5 and 10-Yr Direct and Indirect Costs (in 2021 Canadian dollars), Stratified by SLE and Non-SLE NP States*

Disclosures: A. Clarke, AstraZeneca, 2, GSK, 6, BMS, 2, Exagen Diagnostics, 2; J. Hanly, None; Y. St.Pierre, None; C. Gordon, Centre for Disease Control, 2, 6, Astra-Zeneca, 2, 6, MGP, 2, 6, Sanofi, 2, 6, UCB, 2, UCB, 5, 6; S. Bae, None; J. Romero-Diaz, None; J. Sanchez-Guerrero, None; S. Bernatsky, None; D. Wallace, GlaxoSmithKline, 2, 6, Eli Lilly and Company, 2, 6, AstraZeneca, 2, 6, Aurunia, 2, 6, EMD Serono, 2; D. Isenberg, None; A. Rahman, Lilly, 6; J. Merrill, GlaxoSmithKline, 2, 5, UCB, 2, AbbVie, 2, EMD Serono, 2, Remegen, 2, Celgene/Bristol Myers Squibb, 2, AstraZeneca, 2, 5, Daiichi Sankyo, 2, Servier, 2, Immupharma, 2, Amgen, 2, Janssen, 2, Lilly, 2, Genentech, 2, Resolve, 2, Alpine, 2, Aurinia, 2, Astellas, 2, Alexion, 2, Provention, 2; P. Fortin, Lilly, 1, AbbVie, 1, AstraZeneca, 1; D. Gladman, AbbVie, 2, 5, Amgen, 2, 5, Eli Lilly, 2, 5, Galapagos, 2, 5, Gilead, 2, 5, Janssen, 2, 5, Novartis, 2, 5, Pfizer, 2, 5, UCB, 2, 5, Celgene, 2, 5, Bristol Myers Squibb, 2, 5; M. Urowitz, GlaxoSmithKline, 2, 5, 6, UCB, 2, Lilly, 6, AstraZeneca, 2; I. Bruce, None; M. Petri, Alexion, 1, Amgen, 1, Astrazeneca, 1, 5, Aurinia, 5, 6, Eli Lilly, 5, Emergent Biosolutions, 1, Exagen, 5, Gilead Biosciences, 2, GSK, 1, 5, IQVIA, 1, Idorsia Pharmaceuticals, 2, Janssen, 1, 5, Merck EMD Serono, 1, Momenta Pharmaceuticals, 2, PPD Development, 1, Sanofi, 2, Thermofisher, 5, UCB Pharmaceuticals, 2; E. Ginzler, None; M. Dooley, None; R. Ramsey-Goldman, None; S. Manzi, Astra Zenecs, 2, 5, Cugene, 2, Eli Lilly, 2, Exagen, 2, 5, 10, UCB, 2, GSK, 2; A. Jnsen, None; G. Alarcn, None; R. van Vollenhoven, Bristol Myers Squibb, 2, 5, Eli Lilly, 5, UCB, 2, 5, 6, Pfizer, 2, 6, 12, Support for educational programs; institutional grants, Roche, 12, Support for educational programs; institutional grants, Janssen, 2, 6, AbbVie, 2, 6, AstraZeneca, 2, Biotest, 2, GlaxoSmithKline, 2, 6, Biogen, 2, Galapagos, 2, 6, Gilead, 2, Sanofi, 2, Servier, 2, Vielabio, 2; C. Aranow, GlaxoSmithKline, 2, 5; M. Mackay, None; G. Ruiz-Irastorza, None; S. Lim, Bristol Myers Squibb, 5, GlaxoSmithKline, 2, ACR, 4, AstraZeneca, 5, Pfizer, 2, UCB, 2; M. Inanc, None; K. Kalunian, Amgen, 2, AbbVie, 2, AstraZeneca, 2, Biogen, 2, Bristol Myers Squibb, 2, Eli Lilly, 2, Equillium, 2, Genentech/Roche, 2, Gilead, 2, Janssen, 2, Lupus Research, 5, Pfizer, 5, Sanford Consortium, 5, Vielabio, 2, Aurinia, 2, Alliance, 2, Nektar, 2; S. Jacobsen, None; C. Peschken, AstraZeneca, 2, GlaxoSmithKline, 2, Eli Lilly, 2; D. Kamen, None; A. Askanase, GSK, 2, 5, AstraZeneca, 1, 5, Amgen, 1, Aurinia, 2, Abbvie, 1, Pfizer, 5, Eli Lilly, 5, Idorsia, 5; V. Farewell, None.

To cite this abstract in AMA style:

Clarke A, Hanly J, St.Pierre Y, Gordon C, Bae S, Romero-Diaz J, Sanchez-Guerrero J, Bernatsky S, Wallace D, Isenberg D, Rahman A, Merrill J, Fortin P, Gladman D, Urowitz M, Bruce I, Petri M, Ginzler E, Dooley M, Ramsey-Goldman R, Manzi S, Jnsen A, Alarcn G, van Vollenhoven R, Aranow C, Mackay M, Ruiz-Irastorza G, Lim S, Inanc M, Kalunian K, Jacobsen S, Peschken C, Kamen D, Askanase A, Farewell V. Economic Evaluation of Neuropsychiatric (NP) Lupus in an International Inception Cohort Using a Multistate Model Approach [abstract]. Arthritis Rheumatol. 2021; 73 (suppl 9). https://acrabstracts.org/abstract/economic-evaluation-of-neuropsychiatric-np-lupus-in-an-international-inception-cohort-using-a-multistate-model-approach/. Accessed .

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