A Systematic Review on the Health Equity Disparities in Lupus Treatment: Medicaid Vs. Private Payer Outcomes

OBJECTIVES: Systemic Lupus Erythematosus (SLE) disproportionately affects socioeconomically disadvantaged populations. Access to quality healthcare and health disparities among SLE patients, particularly those with Medicaid versus private insurance, have raised concerns regarding health equity. This systematic review explores disparities in outcomes, costs, resource use, and treatment patterns between Medicaid and private payer SLE patients.

METHODS: A literature search was conducted using PubMed, focusing on studies published between January 2003 and December 2023. Our search terms included SLE, Medicaid, private insurance, health disparities, patient outcomes, healthcare costs, resource utilization, and treatment patterns. Studies included in this review were required to report data on Medicaid and private payer-insured patients with SLE, and their outcomes were assessed in terms of disease management, healthcare costs, healthcare resource utilization, and treatment patterns.

RESULTS: There were 14 relevant studies identified in the search. Among Medicaid-insured SLE patients, 74.8% had moderate/severe SLE, in contrast to 67.4% among commercially insured patients. Adjusted mean healthcare costs for moderate/severe SLE were higher for Medicaid-insured ($56,050) than commercially insured patients ($44,932). Likewise, mild SLE costs were higher for the Medicaid patients ($44,932) than the commercially insured patients ($23,519). Severe flares incurred the highest costs ($11,716). Hospitalization rates were positively correlated with areas having no insurance or Medicaid hospitalizations and ambulatory care-sensitive conditions (r = 0.22, p < 0.0001; r = 0.21, p < 0.0001; r = 0.23, p < 0.0001, respectively). Medicaid expansion states had initially lower odds of preventable lupus hospitalizations (OR 0.958) but adjusting for covariates increased the odds (OR 1.302).

CONCLUSIONS: These findings underscore the economic and healthcare access challenges faced by Medicaid-insured individuals with lupus who are more likely to have moderate/severe SLE, incurring significantly higher healthcare costs than commercially insured counterparts. These disparities highlight the need to improve lupus management for Medicaid-insured individuals.