Purpose Real-world HRU and medical cost analyses support drug development in SLE. The economic burden of SLE as a function of disease severity was quantified for a German cohort.

Methods HRU and cost analyses were performed for patients (≥18 years old) with SLE and compared with those of matched controls for 2009–2014 using the Betriebskrankenkassen (BKK) German Sickness Fund Database. BKK is a branch of the statutory German health insurance. SLE was confirmed in 2009 using the diagnosing physician’s specialty, repeated SLE-related claims, co-diagnosis codes, laboratory tests, or prescriptions. At least 3 years’ data was also required prior to 2009. SLE cases were control matched by age, sex, and baseline Charlson comorbidity index (CCI). Continuous outcomes were compared with nonparametric tests.

Results 1160 patients (mean age: 52 years; median baseline CCI: 2 [females], 3 [males]; baseline CCI range: 1–13) with SLE met all inclusion criteria. Most patients were female (84%) and were diagnosed with SLE before 2009 (85%). In 2009, SLE prevalence was 37.32/100,000 and incidence was 5.96/100,000. Prevalence increased progressively to 47.36/100,000 in 2014. SLE disease severity was characterised as mild, moderate, and severe for 148, 484, and 528 patients, respectively, per ICD-10-GM and medication/procedures codes. Patients with moderate and severe SLE had greater mean annual medical costs in 2009–2014 than matched controls (e.g., in 2009, moderate SLE: €4867 vs €3,380, p<0.0001; severe SLE: €10 001 vs €4,239, p<0.0001). Mean costs and number of outpatient visits, hospital stays, outpatient prescriptions and other benefits, and total number of hospital days were significantly greater for the full SLE population and moderate and severe SLE subpopulations than for matched controls. For example, mean costs for hospital stays, outpatient prescriptions, and other benefits in 2009 were €4335 vs €1,414, €2582 vs €1,087, and €1068 vs €691, respectively, for patients with severe SLE vs controls.

Conclusions Economic burden was greater for patients with moderate to severe SLE than for matched controls. Patients with SLE had greater HRU and costs than matched controls. HRU increased with increasing SLE disease severity. New therapeutics that decrease disease activity could reduce economic burden.