Hospitalisation and Healthcare Costs in Adults with Systemic Lupus Erythematosus in Sweden: A Real-World Observational Cohort Study

OBJECTIVES: Systemic lupus erythematosus (SLE) is a chronic multi-organ autoimmune disease, often with a relapsing-remitting pattern, which causes significant morbidity and mortality. This study estimated the costs and resource burden associated with SLE and disease flares in Sweden.

METHODS: Adult patients with ≥2 hospital visits with a primary diagnosis of SLE between July 2005 to December 2020 were identified in the Swedish National Patient Registry. Follow-up started at the first recorded hospital visit for SLE. Population controls were matched 5:1 on age, sex, and county. Average annual number of outpatient visits, inpatient stays, average length of stay (LOS), and total costs of secondary care and prescription drugs (reported in 2021 SEK) were derived. Data on hospital-administered medications and indirect costs were not available. Flares were identified using an algorithm integrating medications and healthcare used for specified diagnoses and classified as mild, moderate, or severe. Costs per flare were estimated based on hospital visits and prescription medications dispensed within 45 days of the start of the flare.

RESULTS: The 9,672 identified SLE patients (mean age [SD] at inclusion 50.2 years [17.2], 85.5% female) used significantly more healthcare than matched controls, including more outpatient visits (2.75 vs. 0.26 per year), more inpatient stays (0.43 vs. 0.08 per year), longer LOS per admission (13.2 days vs. 9.2 days; all p < 0.0001), and had higher annual healthcare costs (43,758 vs. 7,898 SEK). The average costs per flare (average annual flares per patient) were 3,029 SEK (0.33), 7,683 SEK (1.10), and 49,434 SEK (0.27) for mild, moderate, and severe flares, respectively.

CONCLUSIONS: This nationwide analysis showed that patients with SLE in Sweden use 5-10 times more hospital care than controls, with a higher overall direct costs. Managing flares is a key component of costs in SLE. Effective treatments reducing flare rates could reduce the economic burden of SLE.