SAN DIEGO — Patients with systemic lupus erythematosus in the most severe category of damage states as assessed by the Systemic Lupus International Collaborating Clinics/ACR damage index, or SDI, sustain direct costs that are approximately four times higher and total costs that are nearly twofold higher than patients with the lowest baseline SDIs, according to findings presented at the American College of Rheumatology Annual Meeting.
In the study, researchers enrolled 1,361 patients (90.4% women; 71% white; mean age at diagnosis, 33.1 ± 13.5 years) who met the revised ACR or Systemic Lupus International Collaborating Clinics (SLICC) classification criteria for SLE from six Canadian centers
Participants completed validated questionnaires on the use of health resources, including hospitalizations, medications, physician visits, tests and ED visits, and on lost productivity. The researchers calculated direct costs by multiplying health resources by their 2017 prices in Canada. They used sex-specific wages from Statistics Canada to assess indirect costs, which included loss of time and impaired productivity in labor force and non-labor force activities. Multiple regressions adjusted for age, race/ethnicity and disease duration were used to determine annual costs related to damage states. The researchers calculated long-term estimates of direct/indirect costs by multiplying annual costs related to each level of disease damage by the anticipated duration in each state, predicted using a multi-state Markov model. The mean SLE duration at the completion of the economic questionnaire was 16.8 ± 11.6 years, whereas the mean SLE Disease Activity Index was 2.71 ± 3.21 years and the mean SDI was 1.54 ± 1.87.
The researchers found that, at baseline, the annual direct and total costs were higher in those with SDI of at least 5 (mean annual direct costs, $18,620 Canadian; 95% CI, 15,850-21,930 with SDI ≥ 5 vs. mean annual direct costs, $4,379 Canadian; 95% CI, 2,859-5,900 with SDI state of 0; mean total costs, $46,523; 95% CI, 39,048-53,998 with SDI ≥ 5 vs. $29,147; 95% CI, 24,997-33,998 with SDI of 0). No differences were seen in indirect costs across SDI categories.
Patients with baseline SDIs of at least 5 sustained cumulative direct costs that were 4.2 times higher than those with baseline SDIs of 0, whereas total costs of those with the highest SDIs were almost twice those of patients with the lowest baseline SDIs. Patients with less damage or no damage nevertheless had significantly diminished productivity. Direct costs were exceeded by indirect costs an average of 3.9-fold, emphasizing the significance of lost workforce productivity and the need for workplace and governmental interventions aimed at improving workplace outcomes for patients with SLE, according to the researchers.
“Clearly, there is a need for better tools to measure the functional impairment experienced by our patients with lupus,” said Ann E. Clarke, MD, of the division of rheumatology, University of Calgary, Canada. “Under the guidance of John Hadley and his students, we are developing a frailty index specific to lupus. This will provide constant measures of health deficits and a measure of patient resilience. There clearly is an urgent need for interventions to improve the productivity in both work and non-work life in patients living with lupus.” – by Jennifer Byrne
Choi M, et al. Abstract #2925. Presented at: American College of Rheumatology Annual Meeting; Nov. 4-8, 2017; San Diego.
Disclosures: The authors report no relevant financial disclosures.