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

Cost increases were particularly pronounced among patients with severe systemic lupus erythematosus (SLE), the study found.

A new study based on real-world spending shows how a diagnosis of systemic lupus erythematosus (SLE) can spark dramatic increases in per-patient healthcare costs.

The report, published in the journal Rheumatology Advances in Practice, found the cost to manage patients with moderate and severe SLE doubled in the first decade after diagnosis.

Corresponding author Barnabas Desta, MBA, of drugmaker AstraZeneca, and colleagues noted that SLE is a chronic condition that affects multiple organs, and which commonly occurs alongside comorbidities such as cardiovascular disease and stroke. Those factors, along with adverse events associated with treatment, tend to result in high rates of health care utilization among persons with SLE.

While the broad trend of SLE health care spending has been documented elsewhere, Desta and colleagues said the cost implications of an SLE diagnosis have been less well-studied in the United Kingdom. The investigators therefore decided to use 2 British databases in an effort to understand how health care utilization and spending changed for people once they received an SLE diagnosis.

The authors looked for patients at least 18 years old who were included in the databases between the years of 2005 and 2017. In addition to their SLE diagnosis, patients were stratified based on the severity of their disease, with the classification of mild, moderate, or severe SLE based on an algorithmic analysis of prescriptions and co-morbid conditions.

In total, 802 patients were identified in the database, the large majority of whom had mild (369 patients) or moderate (345 patients) disease. The remaining 88 patients had severe SLE.

The investigators noticed trends in health care spending both before and after the diagnosis of SLE. In the 3 years before diagnosis, mean all-cause costs increased annually, and then hit their highest point in the first year following 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.

Much of the latter increase happened near the end of the decade studied. The authors noted that spending rose sharply among the patients still in the database for years 8-10.

“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 colleagues said.

Patients with moderate and severe SLE had more significant upticks in costs than those with mild disease. The per-year cost increase for patients with severe disease was 4.7-fold higher than the increase for those with mild disease, and severe-SLE patients had 1.6-fold higher annual increases compared to patients with moderate SLE.

In contrast to some earlier studies, Desta and colleagues said they found the biggest driver of medical costs among patients with SLE was primary care. Some previous studies had suggested inpatient hospital stays were the biggest cost.

“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.

Though the study shows the high cost of SLE, it also suggests 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.

Reference

Samnaliev M, Barut V, Weir S, et al. Health-care utilization and costs in adults with systemic lupus erythematosus in the United Kingdom: a real-world observational retrospective cohort analysis. Rheumatol Adv Pract. Published online September 16, 2021. doi:10.1093/rap/rkab071