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CS-07 Economic evaluation of damage accrual in an international SLE inception cohort
  1. Ann E Clarke1,
  2. Ian N Bruce2,
  3. Murray B Urowitz3,
  4. John G Hanly4,
  5. Juanita Romero-Diaz5,
  6. Caroline Gordon6,
  7. Sang-Cheol Bae7,
  8. Sasha Bernatsky8,
  9. Daniel J Wallace9,
  10. Joan T Merrill10,
  11. David A Isenberg11,
  12. Anisur Rahman11,
  13. Ellen M Ginzler12,
  14. Michelle Petri13,
  15. MA Dooley14,
  16. Paul Fortin15,
  17. Dafna D Gladman2,
  18. Jorge Sanchez-Guerrero2,
  19. Kristjan Steinsson16,
  20. Rosalind Ramsey-Goldman17,
  21. Munther A Khamashta18,
  22. Cynthia Aranow19,
  23. Graciela S Alarcón20,
  24. Susan Manzi21,
  25. Ola Nived22,
  26. Asad A Zoma23,
  27. Ronald F van Vollenhoven24,
  28. Manuel Ramos-Casals25,
  29. Guillermo Ruiz-Irastorza26,
  30. S Sam Lim27,
  31. Kenneth C Kalunian28,
  32. Murat Inanc29,
  33. Diane L Kamen30,
  34. Christine A Peschken31,
  35. Soren Jacobsen32,
  36. Anca Askanase33,
  37. Yvan St Pierre34,
  38. Li Su35 and
  39. Vernon Farewell35
  1. 1Division of Rheumatology, Cumming School of Medicine, University of Calgary, Alberta, Canada
  2. 2Arthritis Research UK Epidemiology Unit, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK; and NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre
  3. 3Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Ontario, Canada
  4. 4Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
  5. 5Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico
  6. 6Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
  7. 7Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
  8. 8Divisions of Rheumatology and Clinical Epidemiology, McGill University Health Centre; Montreal, Quebec, Canada
  9. 9Cedars-Sinai/David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
  10. 10Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
  11. 11Centre for Rheumatology, Department of Medicine, University College London, UK
  12. 12Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
  13. 13Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
  14. 14Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
  15. 15Division of Rheumatology, Centre Hospitalier Universitaire de Québec et Université Laval, Quebec City, Canada
  16. 16Center for Rheumatology Research, Landspitali University hospital, Reykjavik, Iceland
  17. 17Northwestern University and Feinberg School of Medicine, Chicago, IL, USA
  18. 18Lupus Research Unit, The Rayne Institute, St Thomas’ Hospital, King’s College London School of Medicine, UK, London, UK
  19. 19Feinstein Institute for Medical Research, Manhasset, NY, USA
  20. 20Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
  21. 21Alleghany Health Network, Pittsburgh, PA, USA
  22. 22Department of Rheumatology, University Hospital Lund, Lund, Sweden
  23. 23Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, UK
  24. 24University of Amsterdam, Rheumatology and Immunology Center, Amsterdam, Noord-Holland, NL
  25. 25Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain
  26. 26Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain
  27. 27Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia, USA
  28. 28UCSD School of Medicine, La Jolla, CA, USA
  29. 29Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
  30. 30Medical University of South Carolina, Charleston, South Carolina, USA
  31. 31University of Manitoba, Winnipeg, Manitoba, Canada
  32. 32Department of Rheumatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
  33. 33Hospital for Joint Diseases, NYU, Seligman Centre for Advanced Therapeutics, New York NY
  34. 34Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
  35. 35MRC Biostatistics Unit, Institute of Public Health, University Forvie Site, Cambridge, UK


Background Little is known about the association of healthcare costs with damage accrual in SLE. We describe the costs associated with damage progression using multi-state modeling.

Methods Patients fulfilling the revised ACR Classification Criteria for SLE from 32 centres in 11 countries were enrolled in the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort within 15 months of diagnosis. Annual data on demographics, SLE disease activity (SLEDAI-2K), damage (SLICC/ACR Damage Index [SDI] if ≥6 months from diagnosis), hospitalizations, medications, dialysis, and utilization of selected medical/surgical procedures were collected. Annual health resource utilization was costed using 2017 Canadian prices. Annual costs associated with SDI states were obtained from multiple regressions adjusting for age, sex, race/ethnicity, and disease duration. As there were relatively few transitions to SDI states 5–11, these were merged into a single SDI state. Five and 10 year cumulative costs were estimated by multiplying annual costs associated with each SDI state by the expected duration in each state, which was forecasted using a multi-state model and longitudinal SDI data from the SLICC Inception Cohort (Bruce IN et al. Ann Rheum Dis 2015;74: 1706– 13). Future costs were discounted at a yearly rate of 3%.

Results 1676 patients participated, 88.7% female, 49.2% Caucasian, mean age at diagnosis 34.6 years (SD 13.4), mean disease duration at enrollment 0.5 years (range 0–1.3 years), and mean follow up 7.8 years (range 0.6–16.9 years). Health resource utilization and annual costs (after adjustment using regression) were markedly higher in those with higher SDIs (SDI=0, annual costs $1847, 95% CI $1120 to $2574; SDI≥5, annual costs $26 772, 95% CI $19 631 to $33 813). At SDI≤2, hospitalizations and medications accounted for 97.1% of direct costs, whereas at SDI≥3, dialysis was responsible for 55.0%.

Five and 10 year cumulative costs stratified by baseline SDI were calculated by multiplying the annual costs associated with each SDI by the expected duration in that state. Five and 10 year costs were greater in those with the highest SDIs at baseline (table 1).

Abstract CS-07 Table 1

Predicted 5 and 10-year cumulative costs stratified by baseline SDI

Conclusions Patients with the highest baseline SDIs incur annual costs and 10 year cumulative costs that are at least 10-fold higher than those with the lowest baseline SDI. By estimating the expected duration in each SDI state and incorporating annual costs, disease severity at presentation can be used to predict future healthcare costs, critical knowledge for cost-effectiveness evaluations of novel therapies.

Acknowledgements The Systemic Lupus International Collaborating Clinics (SLICC) research network received partial funding for this study from UCB Pharmaceuticals.

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