Lupus Low Disease Activity State is Associated with Reduced Direct Healthcare Costs in Patients with Systemic Lupus Erythematosus

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Abstract

Objective Treat to target endpoints for Systemic Lupus Erythematosus (SLE) have been assessed for impact on damage accrual and flare, but whether they impact on the high healthcare utilization and costs in SLE has not been studied. We hypothesized that the recently described lupus low disease activity state (LLDAS) would be associated with reduced healthcare cost. Methods Data from a single tertiary hospital longitudinal SLE cohort were assessed. Baseline demographics, disease activity (SLE Disease Activity Index (SLEDAI)‐2K; physician global assessment, PGA; and, flare index) and medication use were evaluated, and direct healthcare utilization and cost data were obtained from hospital information systems. LLDAS was defined as previously published: briefly, SLEDAI‐2K ≤ 4 with no new activity, PGA ≤ 1, prednisolone ≤7.5mg/day, and optimal standard immunosuppressive agents. Analysis was performed using multivariable linear regression. Results Two hundred SLE patients, contributing 357.8 person‐years observation, were included. A history of lupus nephritis was present in 42%, and damage (SLICC‐ACR damage index >0) was present at study commencement in 57.3%. The mean (±standard deviation) annual direct medical cost per patient was US$7,413 (±US$13,133)/year. In multivariable analysis, increased cost was associated with the presence of baseline organ damage (41.7% increase, P=0.009), and corticosteroid use (>7.5‐15 mg/day, 55.7% increase, P=0.02; > 15 mg/day, 202% increase, P<0.001). In contrast, spending ≥50% of the observation period in LLDAS was associated with a 25.9% reduction in annual direct medical cost (p=0.04). Conclusion Greater time spent in LLDAS was associated with significantly reduced direct hospital healthcare costs among patients with SLE.
Original languageEnglish
Number of pages19
JournalArthritis Care and Research
DOIs
Publication statusAccepted/In press - 8 Jul 2019

Keywords

  • Direct Medical Cost; Lupus Low Disease Activity State; Systemic Lupus Erythematosus

Cite this

@article{7fffbd79d2e54f3aba05865a70177085,
title = "Lupus Low Disease Activity State is Associated with Reduced Direct Healthcare Costs in Patients with Systemic Lupus Erythematosus",
abstract = "Objective Treat to target endpoints for Systemic Lupus Erythematosus (SLE) have been assessed for impact on damage accrual and flare, but whether they impact on the high healthcare utilization and costs in SLE has not been studied. We hypothesized that the recently described lupus low disease activity state (LLDAS) would be associated with reduced healthcare cost. Methods Data from a single tertiary hospital longitudinal SLE cohort were assessed. Baseline demographics, disease activity (SLE Disease Activity Index (SLEDAI)‐2K; physician global assessment, PGA; and, flare index) and medication use were evaluated, and direct healthcare utilization and cost data were obtained from hospital information systems. LLDAS was defined as previously published: briefly, SLEDAI‐2K ≤ 4 with no new activity, PGA ≤ 1, prednisolone ≤7.5mg/day, and optimal standard immunosuppressive agents. Analysis was performed using multivariable linear regression. Results Two hundred SLE patients, contributing 357.8 person‐years observation, were included. A history of lupus nephritis was present in 42{\%}, and damage (SLICC‐ACR damage index >0) was present at study commencement in 57.3{\%}. The mean (±standard deviation) annual direct medical cost per patient was US$7,413 (±US$13,133)/year. In multivariable analysis, increased cost was associated with the presence of baseline organ damage (41.7{\%} increase, P=0.009), and corticosteroid use (>7.5‐15 mg/day, 55.7{\%} increase, P=0.02; > 15 mg/day, 202{\%} increase, P<0.001). In contrast, spending ≥50{\%} of the observation period in LLDAS was associated with a 25.9{\%} reduction in annual direct medical cost (p=0.04). Conclusion Greater time spent in LLDAS was associated with significantly reduced direct hospital healthcare costs among patients with SLE.",
keywords = "Direct Medical Cost; Lupus Low Disease Activity State; Systemic Lupus Erythematosus",
author = "Yeo, {Ai Li} and Rachel Koelmeyer and Rangi Kandane-Rathnayake and Vera Golder and Alberta Hoi and Molla Huq and Edward Hammond and Henk Nab and Mandana Nikpour and Morand, {Eric F.}",
year = "2019",
month = "7",
day = "8",
doi = "10.1002/acr.24023",
language = "English",
journal = "Arthritis Care and Research",
issn = "2151-464X",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Lupus Low Disease Activity State is Associated with Reduced Direct Healthcare Costs in Patients with Systemic Lupus Erythematosus

AU - Yeo, Ai Li

AU - Koelmeyer, Rachel

AU - Kandane-Rathnayake, Rangi

AU - Golder, Vera

AU - Hoi, Alberta

AU - Huq, Molla

AU - Hammond, Edward

AU - Nab, Henk

AU - Nikpour, Mandana

AU - Morand, Eric F.

PY - 2019/7/8

Y1 - 2019/7/8

N2 - Objective Treat to target endpoints for Systemic Lupus Erythematosus (SLE) have been assessed for impact on damage accrual and flare, but whether they impact on the high healthcare utilization and costs in SLE has not been studied. We hypothesized that the recently described lupus low disease activity state (LLDAS) would be associated with reduced healthcare cost. Methods Data from a single tertiary hospital longitudinal SLE cohort were assessed. Baseline demographics, disease activity (SLE Disease Activity Index (SLEDAI)‐2K; physician global assessment, PGA; and, flare index) and medication use were evaluated, and direct healthcare utilization and cost data were obtained from hospital information systems. LLDAS was defined as previously published: briefly, SLEDAI‐2K ≤ 4 with no new activity, PGA ≤ 1, prednisolone ≤7.5mg/day, and optimal standard immunosuppressive agents. Analysis was performed using multivariable linear regression. Results Two hundred SLE patients, contributing 357.8 person‐years observation, were included. A history of lupus nephritis was present in 42%, and damage (SLICC‐ACR damage index >0) was present at study commencement in 57.3%. The mean (±standard deviation) annual direct medical cost per patient was US$7,413 (±US$13,133)/year. In multivariable analysis, increased cost was associated with the presence of baseline organ damage (41.7% increase, P=0.009), and corticosteroid use (>7.5‐15 mg/day, 55.7% increase, P=0.02; > 15 mg/day, 202% increase, P<0.001). In contrast, spending ≥50% of the observation period in LLDAS was associated with a 25.9% reduction in annual direct medical cost (p=0.04). Conclusion Greater time spent in LLDAS was associated with significantly reduced direct hospital healthcare costs among patients with SLE.

AB - Objective Treat to target endpoints for Systemic Lupus Erythematosus (SLE) have been assessed for impact on damage accrual and flare, but whether they impact on the high healthcare utilization and costs in SLE has not been studied. We hypothesized that the recently described lupus low disease activity state (LLDAS) would be associated with reduced healthcare cost. Methods Data from a single tertiary hospital longitudinal SLE cohort were assessed. Baseline demographics, disease activity (SLE Disease Activity Index (SLEDAI)‐2K; physician global assessment, PGA; and, flare index) and medication use were evaluated, and direct healthcare utilization and cost data were obtained from hospital information systems. LLDAS was defined as previously published: briefly, SLEDAI‐2K ≤ 4 with no new activity, PGA ≤ 1, prednisolone ≤7.5mg/day, and optimal standard immunosuppressive agents. Analysis was performed using multivariable linear regression. Results Two hundred SLE patients, contributing 357.8 person‐years observation, were included. A history of lupus nephritis was present in 42%, and damage (SLICC‐ACR damage index >0) was present at study commencement in 57.3%. The mean (±standard deviation) annual direct medical cost per patient was US$7,413 (±US$13,133)/year. In multivariable analysis, increased cost was associated with the presence of baseline organ damage (41.7% increase, P=0.009), and corticosteroid use (>7.5‐15 mg/day, 55.7% increase, P=0.02; > 15 mg/day, 202% increase, P<0.001). In contrast, spending ≥50% of the observation period in LLDAS was associated with a 25.9% reduction in annual direct medical cost (p=0.04). Conclusion Greater time spent in LLDAS was associated with significantly reduced direct hospital healthcare costs among patients with SLE.

KW - Direct Medical Cost; Lupus Low Disease Activity State; Systemic Lupus Erythematosus

U2 - 10.1002/acr.24023

DO - 10.1002/acr.24023

M3 - Article

JO - Arthritis Care and Research

JF - Arthritis Care and Research

SN - 2151-464X

ER -