Background/Purpose: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease. SLE tends to peak during prime working years, resulting in a high economic burden due to treatment costs and productivity losses. With the emergence of biologics in the treatment landscape of SLE, there is a renewed interest in understanding the economic burden of SLE. Therefore, the objectives of this study were to: (1) review current evidence on the direct and indirect costs associated with SLE in the USA, UK, France, and Germany; (2) examine the relationship between costs and disease and flare severity; (3) identify gaps in the evidence to inform future research.

Methods: MEDLINE was searched using a combination of cost and SLE-related keywords on November 16, 2018. The search yielded 232 titles and abstracts for screening. The results of the search were cross-checked against an existing systematic review for validation purposes.¹ Only English-language studies published after 2008 with populations from the USA, UK, France, and Germany were included.

Results: Mean annual direct costs in Europe ranged from €3,067 to €4,003 (2011 Euro) compared to $15,000 (2008 USD) to $30,000 (2010 USD) in the USA. Mean annual indirect costs of absenteeism and short-term disability in the USA were reported to be $6,195 and $6,620 (2010 USD), respectively. In the USA studies, medical costs consistently accounted for a greater proportion of the cost burden compared with medication costs, ranging from 65% to 85% depending on disease severity. Within medical costs, inpatient hospitalizations tended to be the primary cost driver. This differed from the European findings where medication costs comprised the largest proportion of total annual costs (UK: 40%, France: 62%, Germany 68%). This difference may be a consequence of when the studies were conducted, as it is unclear whether the use of biologics was captured in the USA studies.

In the USA, higher Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI) scores were associated with increased costs. Direct medical costs were 2.2, 1.3, and 3.4 times higher in severe patients than non-severe patients in UK, France, and Germany, respectively. Each new severe flare increased the total annual direct costs (UK: €650, France: €1,330 [2011 Euro]).

Conclusion: At the time this study was undertaken, there was a limited number of studies examining indirect costs in European countries. Indirect cost data were only available from the USA and most research focused on income loss and work productivity impairment. Little research was found on daily activity loss and caregiver costs. Additional studies aimed at quantifying total costs in SLE are warranted.

¹Meacock R, Dale N, Harrison MJ (2013) The humanistic and economic burden of systemic lupus erythematosus. Pharmacoeconomics 31 (1): 49-61.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-direct-and-indirect-costs-of-illness-associated-with-systemic-lupus-erythematosus-in-the-usa-uk-france-and-germany-a-structured-review/