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Abstract
Objective To describe treatment patterns and the economic burden of cutaneous lupus erythematosus (CLE) using data from a large, commercial insurance database in the United States. Existing data are relatively scarce and outdated.
Methods Adults with ≥1 inpatient diagnosis or ≥2 outpatient diagnoses (minimum 30 days/maximum 365 days apart) of DLE (ICD-10: L93.0, H01.12) or SCLE (ICD-10: L93.1) between 1 January 2018 and 30 June 2021 were selected from the MerativeTM Marketscan® US medical claims database. The frequency and rate of dispensed prescriptions, annualized health service utilization, and annualized direct healthcare costs were described. Subgroup analysis among patients with/without concomitant systemic lupus erythematosus (SLE; ICD-10: M32) was performed.
Results The study included 11,932 patients with DLE and 1634 with SCLE; 47.6% and 30.6%, respectively, had a prior co-diagnosis of SLE. Glucocorticoids were the predominate treatment (table 1). Hydroxychloroquine was used in 58.0% of patients with DLE (DLE with SLE: 68.7%, DLE without SLE: 43.3%) and 65.4% with SCLE (SCLE with SLE: 74.4%, SCLE without SLE: 58.6%). Mean annualized outpatient visits were 31.87 for DLE and 28.19 for SLE, and mean length of hospital stay was 12.4 and 8.1 days, respectively. Respective mean annualized direct costs of $44,188 and $30,219 were reported (DLE with SLE: $63,039, DLE without SLE: $27,056; SCLE with SLE: $45,958, SCLE without SLE: $23,177). Costs were driven largely by outpatient claims (figure 1). During the observation period, 21.7% of DLE and 18.2% of SCLE patients who initially did not have an SLE co-diagnosis were diagnosed with SLE.
Conclusions A substantial proportion of CLE patients developed concomitant SLE, which drove medical resource utilization and costs, resulting in an economic burden 3–4 times higher than that previously reported.
Acknowledgements Merck (CrossRef Funder ID: 10.13039/100009945) sponsored the study and funded editorial support by Bioscript Group.
Percentage of DLE and SCLE patients prescribed glucocorticoids
Annual per-patient overall direct costs for DLE (A) and SCLE (B) were driven largely by outpatient costs. Inpatient costs were proportionately higher for DLE. Pharmacy costs were proportionately higher for SCLE. Emergency department costs were relatively low. All values shown in USD.
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