Healthcare Resource Utilization Among Systemic Lupus Erythematosus Patients in the United States

OBJECTIVES: The aim of this study is to assess the healthcare resource utilization (HCRU) among systemic lupus erythematosus (SLE) patients in the US.

METHODS: We used the MarketScan Commercial Claims and Medicare Supplemental Databases for this retrospective cohort study. Patients initiating hydroxychloroquine or belimumab therapy between April 1, 2016, to June 30, 2019, with at least 6months of continuous enrollment both before and after index date were included. Therapy initiators were required to have at least one SLE diagnosis in the 180days preceding index date, and to confirm SLE there should be at least 2 SLE diagnosis between 60 to 365days apart. In addition to estimating the Charlson Comorbidity Index (CCI), prevalence of hypertension, hyperlipidemia, obesity, cerebrovascular diseases, thrombosis, renal disease, chronic obstructive pulmonary disease, hypothyroidism, osteoarthritis, osteoporosis, fibromyalgia, depression, polyneuropathy, solid tumor, and metastatic cancer were assessed. Patients were followed until disenrollment or end of study period (December 2019). All cause outpatient office visits, emergency department admissions, and inpatient admissions were the outcomes of interest.

RESULTS: 8,449 SLE patients met the enrollment criteria. 91% were female and the median age was 46years. 55% patients were insured through either an Exclusive Provider Organization (EPO) or Preferred Provider Organization (PPO). There was a high burden of comorbidities among this group where the prevalence of hypertension, hyperlipidemia, hypothyroidism, depression, obesity, and osteoarthritis were 34%, 21%, 17%, 14%, 13%, and 11% respectively. The mean CCI among these patients was 1.76. Median patient follow-up days was 635. During this period the mean per patient per month office visit, emergency department admission, and inpatient admission numbers were 1.48, 0.06, and 0.02 respectively.

CONCLUSIONS: We found that active treatment for SLE imposes financial burden on healthcare in commercially insured patients in the US. Further studies are warranted to identify the factors associated with HCRU.