Background/Purpose: Lupus nephritis (LN) is one of the most serious complications of systemic lupus erythematosus (SLE), which develops in about one-third of SLE patients within 10 years of initial diagnosis. LN is associated with considerable morbidity, including an increased risk of end-stage kidney diseases (ESKD), that may impose a substantial economic burden on the healthcare system. The objective of our study was to review and summarize the evidence on costs and healthcare resource utilization (HCU) in patients with LN.

Methods: A targeted literature review was conducted using MEDLINE/Pubmed and Embase to identify studies in adult and juvenile patients with diagnosed LN. A search strategy was developed separately for the two databases to identify relevant peer-reviewed articles published in English between March 2012 and March 2022, and conference abstracts indexed in Embase since 2019. All records were screened by a single reviewer according to pre-specified inclusion and exclusion criteria.<

Results: Of 4,216 records identified in the medical databases, 14 studies reported on costs and HCU in patients with LN. The majority of studies were conducted in adult patients from the United States (US) (n=9) or Sweden (n=2). The remaining studies included juvenile (n=1) or both adult and juvenile patients (n=2). In the US, adult SLE patients with LN had significantly higher utilization of outpatient visit-related services and had more hospitalization-based events per year with approximately 6-day longer lengths of stay, compared to matched patients without SLE. Mean healthcare costs of LN management ranged from $33,500 to $51,000 per year, being 5-7-times higher compared with matched non-SLE controls. Active LN and ESKD further increased mean annual healthcare costs to $79,000 and $262,000 per year, respectively. Among 27,000 hospitalizations of children and adolescents with SLE in the US, over half the inpatient admissions were for patients with LN with significantly longer length of stay compared to pediatric inpatients without LN (p< 0.01). In Sweden, SLE patients with LN incurred significantly higher mean annual total, direct and indirect cost (Swedish krona [SEK] 229,000) compared to SLE patients with arthritis (SEK 193,000) and matched general population (SEK 60,000) (p< 0.05). Moreover, total direct costs and its components (inpatient, pharmaceutical) were significantly higher in SLE patients with nephritis than in those without nephritis (p=0.0001).

Conclusion: Development of LN in SLE patients is associated with higher incremental cost of care compared with SLE patients with other manifestations, and patients without SLE in the US and Europe. The direct healthcare costs are especially increased in patients with active disease and those with ESKD, suggesting there is a high unmet need for effective therapies to treat LN, prevent its complications, and reduce economic burden on the healthcare systems.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/healthcare-resource-utilization-and-costs-of-management-of-lupus-nephritis-in-adult-and-juvenile-patients-with-systemic-lupus-erythematosus/