Friday, 20 Apr 2018

You are here

Health Economics of SLE

A number of presentations over the past few days have addressed the health economics of SLE.

Clarke et al (abstract 2811) studied the costs associated with damage states in a large Canadian lupus cohort as well as in the SL ICC cohort (abstract 2925).

In the first study, 1361 SLE patients from across Canada were studied and the annual direct and indirect costs of care where assessed for the whole cohort as well as according to the level of damage measured by the SLICC damage index. In this study they found that the cumulative direct costs over a 10-year period increased with levels of damage and the direct costs of care were 4.2 fold higher in those with most damage. Interestingly however, the indirect costs over a 10-year period were quite similar across levels of damage accrued. Importantly however, the indirect costs where almost four-fold higher than the overall direct costs of care for lupus patients.

In the SLICC cohort (abstract 2925) a similar analysis was undertaken in 457 patients from SLICC centres across the globe. The same trend was noted with a 4.3-fold increase in direct costs amongst the group with the highest levels of damage compared to those with no damage. Again, there was a similar level of indirect costs across damage groups, and the indirect cost being approximately 4-fold higher than the direct health care costs. Reasons for these high indirect costs include lost productivity and lost opportunities related to their disease (these were both more important that absenteeism i.e. days lost from work).

Abstract 188 also assessed healthcare costs in a cohort of 200 SLE patients from a single cohort in Australia. This group found that the annual costs were significantly greater in patients with high disease activity and in those who had damage at baseline and in particular patients who had persistent disease activity over follow-up, those with renal disease and those who used glucocorticoids. Meeting criteria for LLDAS (lupus low disease activity state) for more than 50% of the follow-up period was associated with approximately 25% reduction in annual direct medical costs. Similarly,abstract 195 also assessed healthcare utilisation and resource use in 1160 SLE cases identified from the German statutory health insurance database in 2009. Lupus patients had almost twice the total medical costs than matched controls (Euro 6895 versus Euro 3692 P<0.0001). Patients with moderate and severe lupus also had significantly higher healthcare costs in patients with mild disease.

These studies add significant new data to this field. Overall they show that patients with lupus incur much higher direct health care costs than non-lupus patients. The direct costs increase with higher disease activity and with increasing levels of damage. Getting patients into a low disease activity state reduces overall healthcare costs. The data from Clarke’s group however highlights the fact that indirect costs due to for example, lost productivity and lost opportunities for work results in indirect costs associated with lupus being much higher (almost 4-fold higher) than the direct costs. These appear to be less influenced by damage. We therefore need to look more broadly at lupus patients, addressing factors such as fatigue, health-related quality of life and work rehabilitation approaches to address the considerable indirect costs associated with this condition.

Add new comment

More Like This

Wear Your Pajamas to Work for Lupus

I suspect that everyone in rheumatology has a special place in their hearts for lupus patients. Their disease is so cruel, and we have so little to offer them, but the young women (and some men) that I treat keep battling on. The longer I have cared for them, the more I wanted to do for them. Managing their illness alone did not seem like enough. 

SynBioSe: Combo Rituximab and Belimumab Succeeds in Severe Refractory Lupus

One of the driving pathogenic mechanisms in systemic lupus erythematosus (SLE) is the generation of immune complexes capable of inducing netosis (NET formation) and NET-derived DNA that may be an amplifying autoantigen and give rise to anti-nuclear autoantibodies (ANAs). 

Increased Comorbidity Burden in Lupus African Americans

Researchers from Vanderbilt University Medical Center used electronic health records (EHR) to perform a phenome-wide study comparing African American (AA-SLE) and Caucasian (C-SLE) with systemic lupus erythematosus (SLE) and found more comorbidities in AA-SLE, especially renal, cardiovascular, and infectious diseases.

The Consequences and Cure of Hepatitis C

I spent this past week seeing hepatitis C patients with our hepatologists, and being a rheumatologist, I was looking forward to seeing extra-hepatic manifestations of HCV that we read about in text-books - cryoglobulinemic vasculitis, sicca syndrome, porphyria cutanea tarda and many others. I suppose I should not be surprised that the week passed without seeing a single one of these. 

mTOR Inhibition with Sirolimus Effective in Lupus

Lancet reports that 12 months of sirolimus treatment is associated with improvement in lupus disease activity presumeably by correction of pro-inflammatory T-cell activity.