Background/Purpose:  Several international studies have shown that systemic lupus erythematosus (SLE) has a considerable financial burden on patients and the health-care economy. Little recent information is available in most European countries about the cost of SLE care (treatment strategies, healthcare pathways, medical resource utilization), especially for patients with moderate to severe disease to make valid comparison with other countries. The aim of this study was to evaluate the annual direct medical costs of the management of adult SLE with active disease in the UK.

Methods:  A multi-centre retrospective chart review involving four specialist lupus centres in the UK recruited 86 SLE patients: 38 severe and 48 non severe patients. At inclusion, patients had to have: 1) at least one change (increase in dose and/or new treatment) in treatment related to current SLE activity, and /or a new manifestations and/or worsening of clinical symptoms of SLE; or, 2) presence of at least one biomarker of SLE activity and concurrently, the presence of at least one clinical and/or hematological feature of SLE. Two-year direct costs were obtained by summarizing all the health resource costs related to laboratory and imaging tests, medical treatment, visits to doctors, day hospitalization, day surgery, emergency room visits, inpatient stays and rehabilitation stays.

Results:  Of the patients studied, 68 (94.4%) were female. The mean age was 45.5 (±13.9) years and the mean duration of SLE was 11.9 (±8.3) years. At baseline, 48/86 (55.8%) of patients had relapsing-remitting SLE and 29/86 (33.7%) had chronically active SLE; 73/86 (84.9%) of patients received corticosteroids, 63/86 (73.3%) antimalarials, 48/86 (55.8%) immunosuppressants and 17/86 (19.8%) NSAIDS. No biological drugs were prescribed at inclusion. The mean (SD) SELENA-SLEDAI score was 7.7 (5.7), and was statistically significantly greater in severe patients (9.6 vs 6.1, p=0.004). Organ damage was present in 34/86 (39.5%) of patients. Anti-dsDNA antibodies were tested in 83/86 (96.5%) at baseline; of which 53/83 (63.9%) were positive. 

The median annual direct medical cost of management of adult SLE patients with active autoantibody positive disease on medication for SLE was £2855.87 (US$4389.02) (mean [SD]: £3230.65 [£2333.21] (US$4,964.98 [US$3585.77]). The minimum and maximum costs (min: £389.06 (US$597.92), max: £9701.52 (US$14909.66) respectively) showed the wide range of costs, associated with a wide spectrum of disease activity and complications needing intervention in these lupus patients. The mean annual direct medical cost was 2.2 times higher in severe than in non-severe SLE patients (p<0.001).

Conclusion:  The trend in terms of direct costs for treating active SLE patients and the marked gradient associated with increasing disease severity are consistent with Sutcliffe et al (2001), which calculated direct costs at £2613 and higher disease activity was associated with increased costs. There are very few published studies attempting to calculate the direct costs of SLE and this study provides current and reliable source of cost data for active SLE patients in the UK and comparable healthcare systems.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-cost-of-management-of-adult-active-systemic-lupus-erythematosus-in-the-uk/