Ai Li Yeo1,2, Rachel Koelmeyer1, Rangi Kandane-Rathnayake1, Vera Golder1,2, Alberta Hoi1,2, Molla Huq3,4,5, Edward Hammond6, Henk Nab6, Mandana Nikpour3,5, Eric F Morand1,2. 1. Centre for Inflammatory Diseases, Monash University, Clayton, VIC, 3168, Australia. 2. Department of Rheumatology, Monash Health, Clayton VIC 3168, Australia. 3. The University of Melbourne, Parkville VIC 3010, Australia. 4. Department of Epidemiology and Preventive Medicine, Monash University, Clayton VIC 3168, Australia. 5. St Vincent's Hospital Melbourne, Fitzroy VIC 3065, Australia. 6. AstraZeneca, 1 Medimmune Way Gaithersburg, USA& Cambridge CB2 8PA, United Kingdom.
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. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
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 SLEpatients, 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. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
Entities:
Keywords:
Direct Medical Cost; Lupus Low Disease Activity State; Systemic Lupus Erythematosus
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