Systemic lupus erythematosus (SLE or lupus) is a chronic immune-driven disease. Like many chronic conditions, SLE can place a significant financial burden on patients, their families and the healthcare system.1,2,3 AstraZeneca has gathered real-world evidence to understand what drives this economic burden and the potential solutions available. Across multiple countries, we found that earlier diagnosis and treatment are important to lowering the costs of SLE by reducing the risk of disease progression and flare frequency, protecting patients from organ damage, and improving their quality of life.2,7,8,10,11
This systemic condition is experienced differently by each patient and can cause a wide range of symptoms, including fatigue, pain, rashes, joint swelling, and fevers.4 Some patients may even live with SLE for many years before receiving a diagnosis.3 As their condition progresses, patients may develop more severe disease and organ damage over time, resulting from both the disease and the frequent use of corticosteroids used to manage their condition.5 Consequently, organ damage and more severe disease characteristics often require more costly care to manage their condition.6
Just consider research recently presented at the European E-Congress of Rheumatology 2020, which revealed that the direct costs of care for patients with moderate or severe SLE in the UK are substantial, increase in the years after diagnosis, and become greater over time compared to patients with mild SLE.7 A gradual increase in healthcare costs was also observed, even in the years prior to SLE diagnosis, with costs increasing by disease severity.7 In the US, higher annual costs are also seen for more severe SLE ($52,951) than moderate and mild forms of the condition ($28,936 and $21,052, respectively).8 This represents a significant economic impact, while also reinforcing the importance of managing SLE disease activity early to reduce the costs associated with disease progression and prevent organ damage.9,10
By analysing retrospective data across the United States, United Kingdom, Germany, and Australia, our findings reveal the association between SLE severity, disease flares and higher healthcare costs is consistent across healthcare systems, even accounting for different timeframes and methodologies used in various research.2,7,8,10,11
The highest drivers of these costs are consistently primary and outpatient care. In the years following diagnosis, most patients progress to severe SLE and pharmacy expenses increase as the presence of comorbidities grows.7 People with more severe forms of SLE also experience a significantly greater number of hospitalizations, as witnessed across both Germany10 and the United States.8
We have also learned that the type of SLE care delivery is not constant over time,2 given the unpredictable disease flares and remissions that vary by disease severity and from person to person.12 In the UK and US for instance, the vast majority of patients experience one or more flares in the first year after diagnosis.13,14 The frequency and severity of a patient’s time to first disease flare also increases with disease progression (61 days for severe SLE vs. 84 days for mild SLE). Many patients with moderate or severe SLE, or those with a comorbidity, may not yet have received any treatment despite a shorter time to the first disease flare13, which in turn is associated with higher medical costs.11
This is a key finding given that, as we observed in the US, the cost associated following for an SLE flare over the next 90 days is $27,468 in severe flares, compared to $8,582 in moderate flares and $3,312 for mild flares.14 In contrast, data in Australia also show that maintaining longer periods of low disease activity both improves outcomes and reduces costs. By achieving a ‘treat-to-target’ objective of a lupus low disease activity state ≥50% of the time, clinicians can potentially reduce annual direct medical costs by 47%.11
For long-term treatment of patients with SLE, treat-to-target can also prolong a patient’s life. Across four continents, the extent of organ damage is associated with poorer health outcomes, including a reduced quality of life and greater mortality rate, which remains consistent despite differences between healthcare systems and life expectancies.15 In fact, mortality rates increase by 34% for just every 1-unit increase in organ damage.15*
We continue to expand our research to other regions, countries, and continents around the world. However, with only one new medicine approved for lupus in the last 60 years, new treatments are also needed to address the significant unmet medical needs faced by patients and providers, including insufficient disease control16, comorbidities7 and the toxicity of frequently used corticosteroids.5,17
By advancing and deepening our understanding of immune diseases, such as SLE, we can help address unmet medical needs to better manage a patient’s condition, maintain a low disease state and therefore require less care, leading to better healthcare outcomes and lowering the financial burden of SLE.
* As measured by the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI), which measures irreversible damage in 12 different organ systems in patient with SLE and risk of mortality.
1. Al Sawah S, Daly RP, Foster SA, et al. The caregiver burden in lupus: findings from UNVEIL, a national online lupus survey in the United States. Lupus. 2017 Jan;26(1):54-61. Accessed June 2020.
2. Hammond ER, Murimi IB, Lin DH, et al. Health Care Utilization and Costs of Systemic Lupus Erythematosus in the United States: A Systematic Review [poster]. Presented at: The European League Against Rheumatism, EULAR, European Congress of Rheumatology 2017; 14-17 June 2017. Abstract ID: SAT0227. Accessed June 2020.
3. Lupus Foundation of America. Lupus facts and statistics. Available at https://www.lupus.org/resources/lupus-facts-and-statistics. Accessed June 2020.
4. American College of Rheumatology. Guidelines for referral and management of systemic lupus erythematosus in adults. Arthritis & Rheumatology. 1999; 42:1785-1796. Accessed June 2020.
5. Al Sawah S, Zhang X, Zhu B, et al. Effect of corticosteroid use by dose on the risk of developing organ damage over time in systemic lupus erythematosus-the Hopkins Lupus Cohort. Lupus Sci Med. 2015;2(1):e000066. Published 2015 Mar 11. doi:10.1136/lupus-2014-000066
6. Kan HJ, Song X, Johnson BH, et al. Healthcare utilization and costs of systemic lupus erythematosus in Medicaid. Biomed Research International. doi:10.1155/2013/808391. Accessed June 2020.
7. Samnaliev M, Barut V, Weir S, et al. Health Care Utilization and Costs in Adults With Systemic Lupus Erythematosus in the United Kingdom: A Real-World Observational Retrospective Cohort Study [poster]. Presented at: The European League Against Rheumatism, EULAR, European E-Congress of Rheumatology 2020; 3-6 June 2020. Abstract ID: THU0550. Accessed June 2020.
8. Murimi I, Dora L, Hong K, Tierce J, et al. Health Care Utililization and Costs of Systemic Lupus Erythematosus by Disease Severity in the United States. The Journal of Rheumatology 2020. Accessed June 2020.
9. Samnaliev M, Barut V, Weir S, et al. Health Care Utilization and Costs in Adults With Systemic Lupus Erythematosus in the United Kingdom: A Real-World Observational Retrospective Cohort Study [poster]. Presented at: The European League Against Rheumatism, EULAR, European E-Congress of Rheumatology 2020; 3-6 June 2020. Abstract ID: THU0550. Accessed June 2020.
10. Hammond E, Freidel H, Garal-Pantaler E, et al. Health care resource use (hru) and medical cost analyses as a function of systemic lupus erythematosus (sle) disease severity: analysis of claims data of a german sickness fund. Lupus Science & Medicine. 2018;5:doi: 10.1136. Accessed June 2020.
11. Yeo AL, Koelmeyer R, Kandane-Rathnayake R, et al. Lupus Low Disease Activity State is Associated with Reduced Direct Healthcare Costs in Patients with Systemic Lupus Erythematosus [published online ahead of print, 2019 Jul 8]. Arthritis Care & Research (Hoboken). 2019;10.1002/acr.24023. Accessed June 2020.
12. Mirzayan M, Schmidt R, Witte T. Prognostic parameters for flare in systemic lupus erythematosus. Rheumatology. 2000; 39(12):1316-1319. Accessed June 2020.
13. Langham J, Barut V, Samnaliev M, et al. Disease Severity, Comorbid Conditions, Treatment Patterns, and Flares in Adults With Systemic Lupus Erythematosus in the United Kingdom: A Real-World Observational Retrospective Cohort Analysis [poster] Presented at: The European League Against Rheumatism, EULAR, European E-Congress of Rheumatology 2020; 3-6 June 2020. Abstract ID: SAT0216. Accessed June 2020.
14. Jiang M, Desta B, Near A, et al. Frequency, Severity and Costs of Flares Increase with Disease Severity in Newly Diagnosed Systematic Lupus Erythematous: A Real-World Cohort Study, United States, 2004–2015 [poster]. Presented at: ACR/ARP Annual Meeting 2019; November 8-13, 2019. Accessed June 2020.
15. Murimi-Worstell I, Lin D, Nab H, et al. Association between organ damage and mortality in systemic lupus erythematosus: a systematic review and meta-analysis. BMJ Open. 2020;10:e031850. doi: 10.1136/bmjopen-2019-031850. Accessed June 2020.
16. Harris, J, Morand, E. Editorial: Focus on Systemic Lupus Erythematosus. Frontiers in Immunolgy. 2016 ; doi: 10.3389/fimmu.2016.00400. Accessed June 2020.
17. Mahieu, M, Strand V, Simon Lee S, et al. A critical review of clinical trials in systemic lupus erythematosus. Lupus. 2016; 25(10), 1122–1140. Accessed June 2020.
Veeva ID: Z4-25870
Date of preparation: July 2020