SLE Diagnosis Leads to Long-term Spike in Health Care Costs, Study Finds

The study found that patients with severe systemic Lupus Erythematosus (SLE) had the highest cost increases.

A new study, based on real-world healthcare spending, shows how a diagnosis for systemic lupus can cause dramatic increases in per-patient healthcare expenses.

The report Published in the journal Rheumatology Advances in PracticeAccording to a study, the cost of managing patients with severe and moderate SLE doubled within the first decade of diagnosis.

Barnabas, MBA, a coresponding author at drugmaker AstraZeneca with colleagues, noted that SLE can affect multiple organs and is often associated with comorbidities like stroke or cardiovascular disease. SLE sufferers are more likely to use health care than others due to these factors and other adverse events.

Although the general trend in SLE health care spending has been documented elsewhere on the web, Desta and his colleagues believe that the cost implications of a SLE diagnosis have not been well-studied in the United Kingdom. To understand how SLE patients’ health care spending and utilization changed, the investigators used 2 British databases.

The authors searched for patients between the ages of 18 and 20 who were included within the databases in the years 2005 and 2017. Patients were classified according to the severity of their disease. This was done using an algorithmic analysis based upon prescriptions and co-morbidities.

The database contained 802 patients, of which the majority had mild (369 patients) and moderate (345 patients). The remaining 88 patients suffered from severe SLE.

The investigators noted trends in health-care spending before and following the diagnosis of SLE. The mean all-cause cost of SLE increased each year for the three years prior to diagnosis. They reached their highest point the first year after diagnosis.

Adjusted per-patient annual costs were US$6114 (£4,476) higher in the first year after diagnosis compared to the baseline of 3 years before diagnosis. By year 10 following diagnosis, costs were US$14,411 (£10,550) above baseline.

The majority of this increase occurred near the end of the decade being studied. The authors observed that patients who were still in the database during years 8-10 saw a sharp rise in spending.

“This might represent costs associated with long-term SLE care and co-morbid disease; however, this rise should be viewed with caution given the smaller sample size in later years and might be explained by outlier cases (e.g. those with organ damage as a result of SLE),”Desta and his colleagues spoke.

Patients with severe and moderate SLE experienced higher costs than patients with milder diseases. Patients with severe disease had an average cost increase of 4.7 times greater than those with milder diseases. Patients with severe SLE saw a 1.6-fold increase in their annual costs compared to patients with mild SLE.

Desta and coworkers found that primary care is the main driver of medical costs for patients with SLE. This was contrary to previous studies. Previous studies suggested that inpatient hospital stays were the most expensive.

“This might reflect differences in care delivery, the generally lower costs of inpatient care in the UK compared with the USA, or differences among the costing methodologies used,”They wrote.

The study does not prove that SLE is expensive but it does suggest benefits to proactive treatment.

“Earlier diagnosis and treatment might reduce disease severity and occurrence of co-morbidities and the high healthcare costs associated with SLE,”They said.

Refer to

Samnaliev M, Barut V, Weir S, et al. A retrospective cohort observational analysis of real-world health-care costs and utilization in adults with systemic Lupus Erythematosus in Great Britain: a real-world observational retrospective cohort study. Rheumatol Adv Pract. Published online September 16, 2021. doi:10.1093/rap/rkab071

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