‘Lupus Low Disease Activity State’ Linked to Reduced Healthcare Costs, Study Confirms

Attaining a low disease state — deemed Lupus Low Disease Activity State or LLDAS — has become a major goal for treatment for people with systemic lupus erythematosus.

Researchers now have demonstrated that achieving this state not only protects patients from organ damage and improves quality of life, it also leads to major reductions in healthcare use and cost. That makes it a cost-effective endpoint.

The study, “Lupus Low Disease Activity State is Associated with Reduced Direct Healthcare Costs in Patients with Systemic Lupus Erythematosus,” was published in the journal Arthritis Care & Research.

Treat-to-Target (T2T), an approach in which therapies are administered to meet specific disease conditions, has been used for designing the best treatment options in a number of diseases.

In systemic lupus erythematosus (SLE), a major goal of treatment is to attain an LLDAS state, which is defined by a set of five conditions:

• an SLE Disease Activity Index (SLEDAI)-2K score — a measure of disease activity in SLE — of 4 or lower, and lack of disease in major organ systems, no haemolytic anaemia and no gastrointestinal activity
• no new signs of disease activity since last assessment
• a physician global assessment (PGA) score of 1 or lower
• a daily dose of prednisolone (or a similar steroid) equal to or below 7.5 milligrams (mg)
• well-tolerated standard doses of immunosuppressive or approved biologic medicines

The use of LLDAS has resulted in significant improvements in patient outcomes, including their quality of life, researchers say. However, whether LLDAS also is associated with reduced healthcare utilization and costs requires further investigation.

To learn more, the researchers evaluated clinical data from 200 people with SLE who visited Monash Health, a public hospital in Melbourne, Australia, at least twice between October 2013 and June 2016. Patients, mostly women (88%) with a median age of 42 years, were followed for a median of 2.1 years.

Researchers also evaluated healthcare utilization — including hospital admissions, emergencies, specialist visits, and investigations — and prescription history.

Overall, 51% of patients spent at least half of the observation period in LLDAS. Among the patients reviewed, 47.5% had active disease during the follow-up period, and more than half (64.5%) experienced at least one mild-to-moderate flare. A total 16% experienced an increase in organ damage during the observation period.

Regarding healthcare use, patients attended a median of six specialist visits per year, five of which were visits to a lupus specialist. Medical investigations occurred 5.2 times a year.

In addition, nearly one-third of patients (31.5%) had at least one emergency department visit during the observation period. Among the 28.5% of individuals admitted for longer than one day, the median length of stay was four days.

Each lupus patient had a mean annual cost of $7,413 a year. A higher disease activity score, and increased musculoskeletal or renal disease activity, all were associated with increased medical costs, as well as disease flares or organ damage at the start of the study.

A daily prednisolone dose above 7.5 mg/day, and use of immunosuppressive or biological agents, also were associated with increased annual medical costs.

On the contrary, spending more than at least half of a person’s time in LLDAS was associated with a significant reduction — by 25.9%, or $1,604 — of the annual direct medical cost.

“We demonstrated that LLDAS, specifically spending ≥50% of the observation period in LLDAS, was associated with reduced direct healthcare costs, while baseline damage and glucocorticoid use were associated with increased costs,” the researchers said.

These findings “demonstrate that targeting a low disease activity state provides benefits to patient care as well as outcomes and better healthcare utilization.”

The results should be used as a “support for the utility of LLDAS as a T2T endpoint in SLE,” the study concluded.