Health care utilization and costs in adults with systemic lupus erythematosus in the United Kingdom: a real-world observational retrospective cohort study

Samnaliev M, Barut V, Weir S, Langham J, Langham S, Wang X, Desta B, Hammond ER. THU0550 Health care utilization and costs in adults with systemic lupus erythematosus in the United Kingdom: a real-world observational retrospective cohort study. Ann Rheum Dis 2020;79(Suppl 1):515–6

Abstract

Background: There is limited real-world evidence demonstrating the long-term direct costs associated with systemic lupus erythematosus (SLE) in the United Kingdom (UK).

Objectives: To describe health care resource utilization and costs in adults with SLE in the UK over time and document costs by disease severity and type of encounter, including primary care, hospitalizations, outpatient visits, and prescription drugs.

Methods: Patients aged ≥18 years with SLE were identified in the linked Clinical Practice Research Datalink – Hospital Episode Statistics database from January 1, 2005, to December 31, 2017. Patients were required to have data from ≥12 months before and after the index date, defined as the date of earliest diagnosis available in the data set. Patients were classified as having mild, moderate, or severe disease using an adapted claims-based algorithm.1 Costs were calculated in 2017 UK pounds from the UK national health care system perspective. We estimated all-cause health care costs and incremental costs associated with each year of follow-up compared with a baseline year (3 years before index) using each patient as his or her own control and adjusting for age, sex, disease severity, and comorbid conditions.

Results: Of the 802 patients identified, 369 (46.0%) had mild SLE, 345 (43.0%) had moderate SLE, and 88 (11.0%) had severe SLE. The mean all-cause cost increased in the 3 years before diagnosis and, in the first year after diagnosis, amounted to £7532 (standard deviation [SD] £9634). This cost varied by disease severity: mild SLE, £5221 (£8064); moderate SLE, £8323 (£9846); and severe SLE, £14,125 (£11,267) (Figure 1). Adjusted total mean annual increase in costs per patient in the overall study population was £4476 (95% confidence interval £3809–5143) greater in the year of diagnosis compared with the baseline year (P<0.0001), adjusted for age, sex, disease severity, and comorbid conditions. Primary care utilization was the leading component of costs during the first year after diagnosis, followed by prescriptions, outpatient care, and inpatient care (Figure 2). Information on biologic use in hospitals is unavailable in these data.

Conclusion: The direct costs of health care for patients with SLE in the UK are substantial and persist over the years after diagnosis. Patients with moderate or severe SLE have higher all-cause costs over time compared with patients with mild SLE. Earlier diagnosis and treatment may reduce disease severity and occurrence of comorbidities, and the associated high health care costs.