Patients with more severe damage caused by systemic lupus erythematosus spend four times as much on healthcare than those with the lowest levels of lupus damage, Canadian researchers said at a recent scientific meeting.
The findings underscore the importance of using more effective therapies in early disease stages, lowering costs in the long run, they argued.
Researchers presented their study, “Economic Evaluation of Damage Accrual in the Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort,” at the 2017 American College of Rheumatology (ACR)/ Association of Rheumatology Health Professionals (ARHP) Annual Meeting in San Diego.
To explore how lupus damage influences healthcare resource use, as well as indirect costs caused by lost productivity over the past year, researchers from the University of Calgary gathered 457 lupus patients from 32 centers in 11 countries. These patients were already enrolled in the Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort — a long-standing lupus research effort.
Included patients had been ill for between four and 17 years. Most were female and nearly half were white.
Researchers measured lupus-associated damage at one time point using the SLICC/ACR Damage Index (SDI). They then used earlier data from the SLICC cohort to estimate how damage affected five and 10-year cumulative costs. In their calculations, they took into account factors such as age, sex, ethnicity and disease duration.
Unsurprisingly, it turned out that annual direct healthcare costs were higher in people with more severe damage, defined as an SDI score of 5 or higher. Among those with a score of 2 or higher, hospitalizations and medications accounted for 54.3 percent of the direct costs. As damage increased to an SDI score of 3 or higher, dialysis made up 55.6 percent of direct costs.
The higher the damage was at the time of the measurement, the higher the estimated costs became over both five and 10 years. In contrast, indirect costs were not linked to the degree of damage. Indirect costs were high even when patients had no or little accumulated damage.
Researchers said other factors such as disease activity, quality of life, fatigue and lower productivity expectations may potentially raise indirect costs linked to a loss of productivity.
While the costs of more effective lupus medications might be limiting their use in early-stage patients, the study shows that early use of effective treatments may lead to lower costs in the long run.