Medical costs and healthcare resource use in patients with lupus nephritis and neuropsychiatric lupus in an insured population

Abstract

Objective:

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that can affect multiple organ systems, including the kidneys (lupus nephritis) and the central nervous system (neuropsychiatric lupus, or NPSLE). The healthcare costs and resource utilization associated with treating lupus nephritis and NPSLE in a large US managed care plan were studied.

Methods:

SLE subjects ≥18 years of age and with claims-based evidence of nephritis or neuropsychiatric conditions were identified from a health plan database. An index date was set as a randomly drawn date from all qualifying claims during 2003–2008 for study subjects. Subjects were matched on the basis of demographic and clinical characteristics to unaffected controls. Costs and resource use were determined during a fixed 12-month post-index period.

Results:

Nine hundred and seven lupus nephritis subjects were matched to controls, and 1062 subjects with NPSLE were matched to controls. Mean overall post-index healthcare costs were significantly higher among subjects with lupus nephritis in comparison to matched controls ($33,472 vs $5347, p < 0.001). Similarly, mean overall post-index healthcare costs were significantly higher among subjects with NPSLE compared to controls ($30,341 vs $4646, p < 0.001). Subjects with lupus nephritis or NPSLE had higher mean post-index numbers of ambulatory visits, specialist visits, emergency department visits and inpatient hospital stays, compared to controls (all p < 0.001).

Limitations:

Additional research, such as medical chart review, could provide validation for the claims-based identification of lupus nephritis and NPSLE subjects. Also, indirect costs were not evaluated in this study.

Conclusion:

Subjects with lupus nephritis or NPSLE have high costs and resource use, compared to unaffected controls.

Keywords::

• Costs
• Resources
• Lupus nephritis
• Neuropsychiatric lupus

Transparency

Declaration of funding

This study was sponsored by MedImmune, LLC.

Declaration of financial/other relationships

DEF has received grant/research support from Abbott, Actelion, Amgen, BMS, Gilead, GSK, NIH, Novartis, Pfizer, Roche/Genentech, UCB; has served as a medical advisory board member to MedImmune, LLC; has served as a consultant to Abbott, Actelion, Amgen, BMS, BiogenIdec, Centocor, CORRONA, Gilead, GSK, NIH, Novartis, Pfizer, Roche/Genentech, UCB; has served on Speakers Bureaus for Abbott, Actelion, UCB (CME only); and has received Honoraria from Abbott, Actelion, Amgen, BMS, BiogenIdec, Centocor, Gilead, NIH, Roche/Genentech. WG, KG, and AWF are full-time employees of MedImmune, LLC. AEC has served as a consultant to MedImmune, LLC, Bristol Myers Squibb, and GlaxoSmithKline/Human Genome Sciences and has received research funding from GlaxoSmithKline/Human Genome Sciences. TB and SRI have served as consultants to MedImmune LLC as employees of OptumInsight.

Acknowledgements

The authors would like to thank Jesse Potash, PhD, at OptumInsight for assistance with preparation of this manuscript.