Wednesday, 12 Dec 2018

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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.

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