OBJECTIVES: Estimate lupus nephritis (LN) direct medical costs and components in the Brazilian private healthcare system.

METHODS: An expert panel was held with five medical specialists to discuss resource use and frequency of LN treatment in private institutions. Literature was reviewed and a questionnaire structured to collect data regarding diagnosis, treatment, follow-up, dialysis and kidney transplantation in patients with LN. Unit costs (in BRL) were obtained from the following public sources: Classificação Brasileira Hierarquizada de Procedimentos Médicos (CBHPM 2020) for medical appointments and procedures; Painel de Troca de Informações na Saúde Suplementar (D-TISS 2016) for hospitalization costs of complications; and Câmara de Regulação do Mercado de Medicamentos (CMED 2021) for drug prices (1 USD=5.64 BRL).

RESULTS: Approximately 76.0% of patients with LN undergo kidney biopsy, of which 48.1% have LN classes III-IV and 21.4% have class V. Around 67.5% of patients with LN classes III-IV experience an average of four renal flares annually. Overall, 20.3% of patients present with refractory LN, 23.8% require dialysis, and 10.3% have end-stage kidney disease (ESKD) requiring kidney transplantation. Cyclophosphamide was the most used immunosuppressant for induction for patients with LN classes III-IV (66.0%), followed by mycophenolate mofetil (46.0%). For maintenance therapy, half of patients used mycophenolate mofetil and 95.0% used oral prednisone. Estimated total annual costs per patient were: BRL 111,033 for LN classes III-IV; BRL 82,863 for LN class V; BRL 106,938 for refractory LN; and BRL 299,376 for ESKD. The main annual cost driver in LN classes III-IV was renal flares (BRL 56,166; 50.6%) and dialysis in LN class V (BRL 28,668; 34.6%).

CONCLUSIONS: Total direct costs increase when LN progresses to ESKD. Improving diagnosis in the face of biopsy access limitations in Brazil and starting appropriate treatment in early stages of LN are important to optimize treatment and help decrease costs.