CLINICAL AND ECONOMIC BURDEN AMONG LUPUS NEPHRITIS PATIENTS WITH END-STAGE RENAL DISEASE: A REAL-WORLD CLAIMS ANALYSIS
Author(s)
Francesca Barion, PhD1, deMauri Mackie, PhD2, Charlotte E. Ward, PhD3, Divya Nagpal, BS4, Jatin Chopra, BS4, Kashish Goyal, BS4;
1argenx, Padova, Italy, 2argenx, Elkins Park, PA, USA, 3ZS Associates, Bethesda, MD, USA, 4ZS Associates, Gurugram, India
1argenx, Padova, Italy, 2argenx, Elkins Park, PA, USA, 3ZS Associates, Bethesda, MD, USA, 4ZS Associates, Gurugram, India
OBJECTIVES: Lupus nephritis (LN) can progress to end-stage renal disease (ESRD), a transition associated with significant clinical and economic consequences. Real-world evidence characterizing the burden among LN patients with ESRD remains limited. This study quantified comorbidity burden, healthcare utilization, and costs for LN patients with and without ESRD in a large U.S. claims database.
METHODS: LN patients were required to have ≥1 SLE diagnosis (ICD-10 M32.x) between 2017-2025 and evidence of renal involvement (LN-specific codes or renal proxies). ESRD was defined using ICD-10 ESRD (N18.6), CKD stage 5 (N18.5), or ≥2 dialysis claims ≥14 days apart. Patients were followed from one year pre-index through three years post-diagnosis. Outcomes included comorbidity burden, healthcare utilization, and all-cause medical costs (2022 USD).
RESULTS: Among 1,402 LN patients, 247 (18%) developed ESRD within 3 years of initial LN diagnosis. ESRD patients had a higher comorbidity burden (mean CCI 3.1 vs 1.8). Multimorbidity was also more common, with ≥64% of ESRD patients having three or more comorbidities across all years, most frequently involving renal, cardiovascular, and gastrointestinal systems. Healthcare utilization reflected this elevated burden. In the year after LN diagnosis, ESRD patients averaged nearly twice as many healthcare visits as non-ESRD patients (75 vs 38) and had more than double the inpatient length of stay (22.7 vs 9.9 days). These utilization levels persisted through years +2 and +3. Annual medical costs in the first post-diagnosis year were more than twice as high for ESRD versus non-ESRD patients ($48K vs $19K), driven primarily by greater inpatient and outpatient service use.
CONCLUSIONS: LN patients who develop ESRD experience markedly greater clinical complexity, healthcare utilization, and medical costs compared with their non-ESRD counterparts. These findings highlight substantial unmet need in this population and reinforce the importance of early interventions that may prevent or delay progression to ESRD and mitigate downstream healthcare burden.
METHODS: LN patients were required to have ≥1 SLE diagnosis (ICD-10 M32.x) between 2017-2025 and evidence of renal involvement (LN-specific codes or renal proxies). ESRD was defined using ICD-10 ESRD (N18.6), CKD stage 5 (N18.5), or ≥2 dialysis claims ≥14 days apart. Patients were followed from one year pre-index through three years post-diagnosis. Outcomes included comorbidity burden, healthcare utilization, and all-cause medical costs (2022 USD).
RESULTS: Among 1,402 LN patients, 247 (18%) developed ESRD within 3 years of initial LN diagnosis. ESRD patients had a higher comorbidity burden (mean CCI 3.1 vs 1.8). Multimorbidity was also more common, with ≥64% of ESRD patients having three or more comorbidities across all years, most frequently involving renal, cardiovascular, and gastrointestinal systems. Healthcare utilization reflected this elevated burden. In the year after LN diagnosis, ESRD patients averaged nearly twice as many healthcare visits as non-ESRD patients (75 vs 38) and had more than double the inpatient length of stay (22.7 vs 9.9 days). These utilization levels persisted through years +2 and +3. Annual medical costs in the first post-diagnosis year were more than twice as high for ESRD versus non-ESRD patients ($48K vs $19K), driven primarily by greater inpatient and outpatient service use.
CONCLUSIONS: LN patients who develop ESRD experience markedly greater clinical complexity, healthcare utilization, and medical costs compared with their non-ESRD counterparts. These findings highlight substantial unmet need in this population and reinforce the importance of early interventions that may prevent or delay progression to ESRD and mitigate downstream healthcare burden.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE83
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
SDC: Systemic Disorders/Conditions (Anesthesia, Auto-Immune Disorders (n.e.c.), Hematological Disorders (non-oncologic), Pain), SDC: Urinary/Kidney Disorders