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Annual direct medical cost of active systemic lupus erythematosus in five European countries
  1. Andrea Doria1,
  2. Zahir Amoura2,
  3. Ricard Cervera3,
  4. Munther A Khamastha4,
  5. Matthias Schneider5,
  6. Jutta Richter5,
  7. Francis Guillemin6,
  8. Gisela Kobelt7,
  9. Frédérique Maurel8,
  10. Anna Garofano8,
  11. Alessandra Perna9,
  12. Miranda Murray10,
  13. Claude Schmitt11,
  14. Isabelle Boucot12
  1. 1Division of Rheumatology, University of Padova, Padova, Italy
  2. 2Internal Medecine Department, La Pitié Salpétrière Hospital, Paris, France
  3. 3Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain
  4. 4Lupus Research Unit, The Rayne Institute, St Thomas’ Hospital, London, UK
  5. 5Department of Endocrinology, Diabetology and Rheumatology, Heinrich Heine University, Düsseldorf, Germany
  6. 6Inserm CIC-EC, Faculty of Medicine, University Hospital, Nancy, Nancy, France
  7. 7Department of Orthopedics, Lund University, Lund, Sweden
  8. 8Health Economics and Outcomes Research, IMS Health, Paris, France
  9. 9Immunology and Hepatitis Centre of Excellence, GlaxoSmithKline, London, UK
  10. 10Access to Medicine Centre of Excellence, GlaxoSmithKline, London, UK
  11. 11Global Health Outcomes, GlaxoSmithKline, London, UK
  12. 12Medical Department, GlaxoSmithKline, Marly-le-Roi, France
  1. Correspondence to Professor Andrea Doria, Division of Rheumatology, University of Padova, Via Giustiniani, 2, Padova 35128, Italy; adoria{at}


Objectives To evaluate the annual direct medical cost of managing adult systemic lupus erythematosus (SLE) patients with active autoantibody positive disease in Europe.

Methods A 2-year, retrospective, multicentre, observational study was conducted in five countries (France, Germany, Italy, Spain and the UK). Data included patients’ characteristics, disease activity and severity, flare assessments and health resource use (eg, laboratory tests, medications, specialist visits and hospitalisations). Costs were assessed from the public payers’ perspective. Cost predictors were estimated by multivariate regression models.

Results Thirty-one centres enrolled 427 consecutive eligible patients stratified equally by disease severity. At baseline, mean (SD) age was 44.5 (13.8) years, 90.5% were women and mean (SD) SLE duration was 10.7 (8.0) years. The SELENA-SLEDAI (11.2 vs 5.3) and SLICC/ACR index (1.0 vs 0.7) scores were higher in severe patients. Over the study period, patients experienced on average 1.02 (0.71) flares/year. The mean annual direct medical cost was higher in severe compared to non-severe patients (€4748 vs €2650, p<0.001). Medication costs were €2518 in severe versus €1251 in non-severe patients (p<0.001). Medications represented 53% and 47% of the total cost for severe and non-severe patients, respectively, primarily due to immunosuppressants and biologics. Flares, especially severe flares, were identified as the major cost predictor, with each flare increasing the annual total cost by about €1002 (p<0.001).

Conclusions The annual direct medical cost of SLE patients in Europe is related to disease severity and flares. Medical treatments were the main cost drivers. Severe flares and major organ involvement were identified as important cost predictors.

  • Systemic Lupus Erythematosus
  • Disease Activity
  • Autoantibodies
  • Economic Evaluations
  • Autoimmune Diseases

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