Background The annual medical costs for systemic lupus erythematosus (SLE) patients can reach up to $62 651 due to complex care needs. This presents a major challenge for all SLE patients, but it is compounded in African American women who experience the disease at a disproportionate rate and severity compared to other demographic cohorts. Peer mentoring interventions are one method examined in other chronic disease populations that has conferred self-management improvements for those patients. The Peer Approaches to Lupus Self-Management (PALS) is one such program, tailored for African American women with SLE,that could lead to cost-effective reductions in disease severity, flares, and subsequent resource utilization and medical costs.
Methods Validated measures of quality of life, disease self-management, disease activity, depression, and anxiety were collected pre- (0 weeks) and post- (12 weeks) intervention. Total direct program costs per-participant were totaled and used to determine average per-unit improvement in programmatic outcome measures. Additionally, the benefit cost ratio and pre- versus post- intervention hospital charges were examined.
Results Twenty mentees completed the study. Statistically significant reductions in disease activity, anxiety, and depression, were observed post-intervention. Patient self-management also improved, however did not reach statistical significance. Total cost per patient was $1,882.83 or $91.14 per week. This yielded a cost benefit ratio of $3423 per 1 unit decrease in the Generalized Anxiety Disorder score, $818 per 1 unit decrease in the PHQ-8 (depression) score, and $85.74 per 1 unit decrease in the SLAQ (disease activity) score. There was a statistically significant difference in pre-intervention hospital charges ($24,289, 95% CI: $55, $48,524) and post- hospital charges ($872, 95% CI: -$324, $2,070) (p=0.047), representing a substantial mean charge savings of $23 426 per individual. The benefit cost ratio was 12.44 per patient which implies that benefits were over 12 times higher than the cost per patient.
Conclusions These findings indicate that the PALS intervention was not only effective in improving patient-level factors such as depression, anxiety, and self-reported disease activity, but the program was also highly cost-effective. These findings suggest that if adopted on a larger scale, this approach could significantly reduce financial burden on patients and medical facilities, as well as improve the quality of life of a high-risk patient population. Future research will need to validate these findings in a larger sample.
Funding Source(s): This project was supported by NIH/NCATS Grant Number UL1, the Rheumatology and Immunology MCRC NIH/NIAMS Grant Number AR062755, NIH/NIAMS K23 AR052364, and NIH/NCRR UL1 RR029882.
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