Background/Purpose: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that may affect multiple organ systems. The clinical manifestations of SLE are heterogeneous, and subjects typically experience periods of disease flares and remission. The objective of this study was to investigate the economic burden and resource use associated with newly diagnosed and existing SLE patients in a large national US insurer.

Methods: Subjects at least 18 years of age and with claims-based evidence of SLE (ICD-9-CM 710.0x) were identified from a health plan database during 2003-2008. Subjects were divided into two cohorts; newly diagnosed and existing based on claims history of SLE. Subjects were matched based on demographic and clinical characteristics at a ratio of 1:3 to unaffected controls. Health care costs and resource use were captured during a 12 month post-index period. A generalized linear model (GLM) was used to predict costs, controlling for demographic and clinical characteristics.

Results: A total of 1,278 newly diagnosed SLE subjects were matched to 3,834 controls, and 10,152 subjects with existing SLE were matched to 30,456 controls. SLE subjects had significantly higher overall mean annual health care costs than matched controls (newly diagnosed: $19,178 vs. $4,909; existing: $15,487 vs. $5,156; both p<0.001).  Inpatient costs were the largest component of medical costs for newly diagnosed subjects, while ambulatory costs were the largest component for existing SLE patients.  When adjusting for clinical and demographic characteristics with a GLM model, the cost ratio of newly diagnosed SLE subjects to controls was 2.15 (95% CI: 1.90-2.42), and the cost ratio of subjects with existing SLE to controls was 2.05 (95% CI: 1.92-2.19).  Presence of pharmacy claims for select medications (including corticosteroids, methotrexate, or cyclophosphamide), and evidence of specific organ involvement (including renal failure, CNS complications, and cardiovascular complications) were each associated with increased costs (all p<0.05). Health care resource use was significantly higher among SLE subjects than matched controls, including average annual numbers of primary care physician visits, specialist visits (nephrologist, rheumatologist, neurologist or dermatologist), emergency department visits, and inpatient hospital stays (all p<0.001).

Conclusion: Economic burden and resource use were high in both newly diagnosed and existing SLE patients compared to unaffected controls in this insured population. Serious complications and immunosuppressant use were associated with increased costs. These findings highlight the unmet need in SLE.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/medical-costs-and-health-care-resource-use-in-patients-with-systemic-lupus-erythematosus-in-an-insured-population/