Background Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that affects as many as 518 persons per 100,000 people in the United States and Europe. However, much of our current knowledge on SLE health care utilization and costs is based on analyses conducted prior to 2011, after which important treatment innovations (e.g., belimumab and, to some extent, rituximab) and health care marketplace changes occurred in the United States.
Objectives The objectives of this systematic review were to summarize the patterns of health care utilization for patients with SLE and to characterize the direct and indirect costs of SLE by disease severity in the United States.
Methods We conducted a systematic literature review of adult patients with SLE in the United States by searching PubMed and Embase for relevant articles written in English and published during January 2000–April 2016. We examined health care utilization measures including emergency department (ED) visits, hospitalizations, outpatient visits, medication use, and adherence. We restricted the analysis to observational studies, excluding case reports and commentaries. All monetary costs were converted to US 2016 $.
Results In total, 4,700 articles were screened, 388 articles were retained for full-text review, and 38 articles were selected for inclusion in this report. Across these 38 studies, mean patient ED utilization rates were 0.9–2.1 visits/year. Mean hospitalization rates were 0.4–2.6 inpatient stays/year, with 5–6 days/stay on average. Patients averaged 10–19 total physician visits/year. More than 90% of patients with SLE had ≥1 visit to a primary care provider annually. In addition, 51–71% visited rheumatologists, and 6–7% visited nephrologists. Health care resource use with respect to ED visits, hospitalization rates, inpatient length of stay, and ambulatory care was greater for patients with lupus nephritis than for patients with SLE without nephritis. Mean annual direct costs from various studies ranged between $15,171–88,445 for patients with SLE regardless of the presence of nephritis. Nearly all studies indicated that mean direct medical costs were greater for patients with moderate or severe disease ($22,300–83,000) than those with mild disease ($8,900–15,000). Mean annual pharmacy costs ranged between $1,572–13,138, accounting for 19–23% of total direct costs, and medical costs ranged between $21,290–82,854. On average, 12–49% of patients were unemployed, and the mean number of sick days/month was 2.3 days. The range of estimates of mean total direct costs for patients with SLE overall were often larger when derived from commercial claims ($21,600–55,400) than from public payers (Medicare and Medicaid, $16,000–23,000).
Conclusions Our findings suggest that patients with SLE, especially those with moderate or severe disease, use considerably more health care services and incur greater direct and indirect costs relative to those with mild disease. Thus, SLE remains a significant driver of health care resource utilization and costs.
Disclosure of Interest E. Hammond Employee of: AstraZeneca, I. Murimi: None declared, D. Lin: None declared, H. Kan Shareholder of: GSK, J. Tierce: None declared, X. Wang Employee of: AstraZeneca, H. Nab Employee of: AstraZeneca, B. Desta Employee of: AstraZeneca, G. C. Alexander: None declared