Background/Purpose: High health care utilization and direct costs have been documented in multiple studies of SLE. The recently described lupus low disease activity state (LLDAS) has been associated with reduced flares and damage accrual. We hypothesized that LLDAS attainment would be associated with reduced healthcare cost.

Methods: This study utilized data from a single tertiary centre cohort of SLE patients (ACR criteria) between October 2013 and June 2016. Baseline demographics, and per visit disease activity (SLEDAI-2K, physician global and flare index) and medication use were matched to healthcare utilization and cost data obtained from hospital information systems. LLDAS was defined as described (Franklyn K, et al. Ann Rheum Dis 2016;75:1615). Statistical analyses were performed using Stata version 14.

Results: 200 SLE patients (88% female, median age 42 years) were followed for 357.8 person-years. A history of lupus nephritis was present in 42%, anti-dsDNA antibodies in 70%, and SLICC damage index (SDI)>0 at study commencement in 57.3%. During the observation period, median (range) time adjusted mean SLEDAI was 4.0 (0–16.9), there were 571 hospitalizations (24.2% multi-day), and 31% of patients had at least one emergency room attendance. The mean (standard deviation) annual direct medical cost per patient was US$7,413 (US$13,133)/year. Patients in the highest quartile of annual cost were more likely to accrue new damage during the observation (34 vs 11%, p<0.001) and had significantly more physician visits, hospitalizations, and emergency room visits (all p<0.001). Mean annual costs were significantly greater in patients with baseline SLEDAI >6 or SDI>0, or who during observation had time-adjusted mean SLEDAI >6, renal disease activity, or used corticosteroids (all p<0.01). In multivariable analysis, baseline organ damage, and moderate–high corticosteroid use (>7.5 mg/day) were significantly associated with increased cost (see table). In contrast, meeting LLDAS criteria for >50% of the observed time was associated with a 25% reduction in annual direct medical cost (p=0.041).

Association of LLDAS with Annual Direct Medical Cost

^#Adjusted for variables in table and geographic distance from the treating centre.

Conclusion: As in previous studies, baseline organ damage, high disease activity, and corticosteroid use were associated with increased cost. Our findings demonstrate that LLDAS attainment is associated with significantly reduced health care cost among patients with SLE.^#Adjusted for variables in table and geographic distance from the treating centre.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/lupus-low-disease-activity-state-is-associated-with-reduced-direct-medical-costs-in-patients-with-systemic-lupus-erythematosus/