COST ANALYSIS OF LUPUS NEPHRITIS IN THE BRAZILIAN UNIFIED HEALTH SYSTEM - RWD STUDY
Author(s)
AndreHayata Hayata, PhD, MD1, Evandro Klumb, MSc2, Gustavo Mondelli, MSc3, Iago D. Silveira, BS4, Larissa Acerbi, BS4, Clarissa Medeiros, MSc4, Veronica E. Mata, MBA, MSc, PhD5;
1Brazilian Society of Rheumatology, Sao Paulo, Brazil, 2Rheumatology Teaching and Assistance Unit at State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil, 3HC UNESP Coordinator, FMB-UNESP Innovation Office, São Paulo, Brazil, São Paulo, Brazil, 4Produtos Roche Químicos e Farmacêuticos S/A, São Paulo, Brazil, 5Produtos Roche Químicos e Farmacêuticos S/A, Market access & HTA Manager, SAO PAULO, Brazil
1Brazilian Society of Rheumatology, Sao Paulo, Brazil, 2Rheumatology Teaching and Assistance Unit at State University of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil, 3HC UNESP Coordinator, FMB-UNESP Innovation Office, São Paulo, Brazil, São Paulo, Brazil, 4Produtos Roche Químicos e Farmacêuticos S/A, São Paulo, Brazil, 5Produtos Roche Químicos e Farmacêuticos S/A, Market access & HTA Manager, SAO PAULO, Brazil
OBJECTIVES: To estimate the direct costs of managing Lupus Nephritis (LN) in adults (≥18 years) from the perspective of the Brazilian Unified Health System (SUS).
METHODS: This retrospective observational study analyzed anonymized claim data from the Brazilian Outpatient Information System (SIA-SUS) for patients treated in 2023. Inclusion required a primary diagnosis of systemic lupus erythematosus (ICD-10 M32), and at least one of the following: documented dialysis or renal biopsy; treatment with mycophenolate mofetil/sodium, azathioprine, cyclophosphamide, cyclosporine, or rituximab combined with nephrology care; ≥2 nephrology outpatient visits; kidney disease-related ICD codes (N00-N19); or kidney transplantation procedures (T861 or Z940). Costs not included in SIA-SUS were estimated using reference values from the Ministry of Health’s Price Panel.
RESULTS: A total of 15,580 LN patients were identified, generating total direct costs of USD 11.97 million for SUS. Dialysis was the main cost driver, accounting for 57.48% (USD 6.88 million) of expenditures, despite only 9.65% (1,503 patients) undergoing the procedure. In contrast, 49.92% (7,777 patients) received mycophenolate mofetil/sodium, generating lower costs of USD 2.58 million. Regional analysis revealed disparities in cost per patient, with the Southeast region showing the highest mean cost (USD 1,191.43), while the South reported the lowest (USD 1,062.71).
CONCLUSIONS: This analysis highlights imbalances in LN care costs within SUS, where dialysis drives most expenditure despite benefiting a minority of patients. Disease progression, not pharmacological therapies, is the main economic burden. Regional cost disparities likely result from unequal healthcare access, including differences in the availability of specialized services and diagnostic resources, as well as delays in diagnosis. These findings underscore the importance of early diagnosis, timely access to effective immunosuppressive treatment, and renal preservation strategies. Addressing barriers to care and tackling regional disparities are essential steps towards better LN management and a sustainable public health system in Brazil.
METHODS: This retrospective observational study analyzed anonymized claim data from the Brazilian Outpatient Information System (SIA-SUS) for patients treated in 2023. Inclusion required a primary diagnosis of systemic lupus erythematosus (ICD-10 M32), and at least one of the following: documented dialysis or renal biopsy; treatment with mycophenolate mofetil/sodium, azathioprine, cyclophosphamide, cyclosporine, or rituximab combined with nephrology care; ≥2 nephrology outpatient visits; kidney disease-related ICD codes (N00-N19); or kidney transplantation procedures (T861 or Z940). Costs not included in SIA-SUS were estimated using reference values from the Ministry of Health’s Price Panel.
RESULTS: A total of 15,580 LN patients were identified, generating total direct costs of USD 11.97 million for SUS. Dialysis was the main cost driver, accounting for 57.48% (USD 6.88 million) of expenditures, despite only 9.65% (1,503 patients) undergoing the procedure. In contrast, 49.92% (7,777 patients) received mycophenolate mofetil/sodium, generating lower costs of USD 2.58 million. Regional analysis revealed disparities in cost per patient, with the Southeast region showing the highest mean cost (USD 1,191.43), while the South reported the lowest (USD 1,062.71).
CONCLUSIONS: This analysis highlights imbalances in LN care costs within SUS, where dialysis drives most expenditure despite benefiting a minority of patients. Disease progression, not pharmacological therapies, is the main economic burden. Regional cost disparities likely result from unequal healthcare access, including differences in the availability of specialized services and diagnostic resources, as well as delays in diagnosis. These findings underscore the importance of early diagnosis, timely access to effective immunosuppressive treatment, and renal preservation strategies. Addressing barriers to care and tackling regional disparities are essential steps towards better LN management and a sustainable public health system in Brazil.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE508
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)