Background/Purpose: SLE is a chronic, debilitating, multisystem autoimmune disorder of connective tissue. In developing new treatment options, the economic burden of SLE should be quantified as a function of disease severity.

Methods: Anonymized data from the Betriebskrankenkassen (BKK) German Sickness Fund Database were used to perform analyses of real-world claims of patients (pts) with SLE. Health care utilization and resource use and costs were assessed annually for 2009–2014 for confirmed pts with SLE identified in 2009 (using repeated claims with SLE diagnosis, co-diagnosis codes, laboratory tests, or prescription treatment and specialty of diagnosing physician) and compared with those of matched controls. Pts were ≥18 years of age and had data available for 2009 and ≥3 years prior to index quarter in 2009. SLE cases were matched to controls by age, sex, and baseline Charlson Comorbidity Index (CCI). Continuous outcomes were compared with a nonparametric test (e.g., Wilcoxon–Mann-Whitney), because most outcome distributions were positively skewed.

Results: Of the 3,290,701 persons with evidence of 3 years of insurance prior to 2009, 1,228 were identified as SLE cases in 2009, representing a prevalence of 37.32 per 100,000 and an incidence of 5.96/100,000 per year. The prevalence increased during the next 5 years to 47.36 per 100,000 in 2014. The final sample included 1,160 confirmed pts with SLE who were ≥18 years of age and had data for 2009. Pts with SLE were 84% female, and had a mean age of 52 years and a baseline CCI range of 1–13. 85% who qualified for the cohort in 2009 had already been diagnosed with SLE before 2009. A combined approach of International Classification of Diseases-10 GM and medication/procedures codes classified SLE disease severity as mild for 148, moderate for 484, and severe for 528 pts. Pts with SLE had significantly greater mean annual total medical costs in 2009 than did matched controls (€6,895 vs. €3,692, p<0.0001), and in all subsequent years evaluated. Moreover, pts with moderate and severe SLE had significantly greater mean annual total medical costs in 2009 than did matched controls (moderate SLE: €4,867 vs. €3,380, p<0.0001; severe SLE: €10,001 vs. €4,239, p<0.0001), and in all subsequent years. Mean costs and numbers of outpatient visits, hospital stays, outpatient prescriptions and other benefits, and total number of hospital days, were significantly greater for the full SLE population and the moderate and severe SLE subpopulations than for matched controls. For example, mean costs for hospital stays, outpatient prescriptions, and other benefits in 2009 were €4335 vs. €1414, €2582 vs. €1087, and €1068 vs. €691, respectively, for pts with mild, moderate and severe SLE vs. controls.

Conclusion: In this analysis, the economic burden of moderate and severe SLE was greater than that of socio-demographically and morbidity–adjusted controls. Pts with SLE were greater users of the health care system and incurred greater total annual medical costs than did matched controls. Health care utilization by pts with SLE increased with disease severity, with the greatest burden for those with severe SLE. New treatments could reduce health care resource use and help alleviate economic burden.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/health-care-costs-of-patients-with-systemic-lupus-erythematosus-sle-versus-control-patients-as-a-function-of-disease-severity-analysis-of-the-betriebskrankenkassen-german-sickness-fund/