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1107 Economic evaluation of hydroxychloroquine use in an international inception cohort
  1. Megan RW Barber1,
  2. Yvan St Pierre2,
  3. John G Hanly3,
  4. Murray B Urowitz4,
  5. Caroline Gordon5,
  6. Sang-Cheol Bae6,
  7. Juanita Romero-Diaz7,
  8. Jorge Sanchez-Guerrero4,
  9. Sasha Bernatsky8,
  10. Daniel J Wallace9,
  11. David A Isenberg10,
  12. Anisur Rahman10,
  13. Joan T Merrill11,
  14. Paul R Fortin12,
  15. Dafna D Gladman4,
  16. Ian N Bruce13,
  17. Michelle Petri14,
  18. Ellen M Ginzler15,
  19. Mary Anne Dooley16,
  20. Rosalind Ramsey-Goldman17,
  21. Susan Manzi18,
  22. Andreas Jönsen19,
  23. Graciela S Alarcón20,
  24. Ronald FVan Vollenhoven21,
  25. Cynthia Aranow22,
  26. Meggan Mackay22,
  27. Guillermo Ruiz-Irastorza23,
  28. S Sam Lim24,
  29. Murat Inanc25,
  30. Kenneth C Kalunian26,
  31. Soren Jacobsen27,
  32. Christine A Peschken28,
  33. Diane L Kamen29,
  34. Anca Askanase30 and
  35. Ann E Clarke1
  1. 1University of Calgary, Alberta, Canada
  2. 2Research Institute of the McGill University Health Center, Montreal, Canada
  3. 3Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
  4. 4Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
  5. 5Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
  6. 6Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
  7. 7Instituto Nacional de Ciencias Médicas y Nutrición, Mexico City, Mexico
  8. 8McGill University Health Centre, Montreal, Canada
  9. 9Cedars-Sinai/David Geffen School of Medicine at the University of California, Los Angeles, USA
  10. 10University College London, London, UK
  11. 11Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
  12. 12CHU de Québec –Université Laval, Québec City, Canada
  13. 13Arthritis Research UK Epidemiology Unit, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre, the University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals National Health Service Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
  14. 14Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  15. 15State University of New York Downstate Medical Center, Brooklyn, New York, USA
  16. 16Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
  17. 17Northwestern University and Feinberg School of Medicine, Chicago, Illinois, USA
  18. 18University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
  19. 19Lund University, Lund, Sweden
  20. 20University of Alabama at Birmingham, USA
  21. 21University of Amsterdam, Rheumatology and Immunology Center, Amsterdam, Noord-Holland, NL
  22. 22Feinstein Institute for Medical Research, Manhasset, New York, USA
  23. 23BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain
  24. 24Emory University School of Medicine, Atlanta, Georgia, USA
  25. 25Istanbul University, Istanbul, Turkey
  26. 26University of California Los Angeles School of Medicine, La Jolla, California, USA
  27. 27Copenhagen Lupus and Vasculitis Clinic, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
  28. 28University of Manitoba, Winnipeg, Manitoba, Canada
  29. 29Medical University of South Carolina, Charleston, USA
  30. 30Hospital for Joint Diseases, New York University Seligman Center for Advanced Therapeutics, New York, New York, USA


Background While there is overwhelming evidence for the beneficial role of hydroxychloroquine (HCQ) in SLE, little is known about its economic impact. We estimated annual direct, indirect, and total costs (DC, IC, TC) associated with HCQ use.

Methods A subset of patients from the Systemic Lupus Erythematosus International Collaborating Clinics (SLICC) inception cohort were assessed annually between 2014 and 2019 for health resource use, lost work-force/non-work-force productivity and concurrent HCQ use. Resource use was costed using 2021 Canadian prices and lost productivity using Statistics Canada age-and-sex specific wages. At each assessment, HCQ dose over the past year and weight were documented and patients were stratified into 1 of 3 HCQ dosage groups: non-users (0 mg/kg/day), low-intensity users (≤ 5 mg/kg/day), or high-intensity users (>5 mg/kg/day). Costs associated with HCQ dose were calculated by averaging all observations within each dosage group. Multiple random effects linear regressions adjusted for the possible confounding of age at diagnosis, sex, race/ethnicity, disease duration, geographic region, education, alcohol use, and smoking on the association between annual DC and IC and HCQ dose. A possible mediating effect of disease damage (SLICC/ACR DI) on these associations was also investigated.

Results 661 patients (89.4% female, 59.3% non-Caucasian race/ethnicity, mean age and mean disease duration at the start of economic assessments was 42.1 years and 9.5 years, respectively) were followed over a mean of 2.8 years. Across 1536 annual assessments, 36.1% of observations were provided by HCQ non-users, 43.1% by low-intensity users (mean dosage 3.4 mg/kg/day), and 20.8% by high-intensity users (mean dosage 5.9 mg/kg/day). Annual adjusted DC were higher in non-users ($9599) versus low-intensity users ($6344) and high-intensity users ($6333) (table 1). When disease damage was included in the regression, there were no significant differences in DC between dosage groups. While unadjusted IC were higher in non-users ($37,610) versus low-intensity users ($32,480) and high-intensity users ($31,418), adjusted IC did not differ. Adjusted TC were higher in non-users ($46,157) versus low-intensity users ($39,257) and high-intensity users ($37,634).

Abstract 1107 Table 1

Unadjusted and adjusted annual direct, indirect, and total costs (in 2021 Canadian dollars) stratified by HCQ dose. Values are the mean (95% CI)

Conclusion SLE patients reported higher adjusted annual DC and TC during periods of HCQ non-use versus periods of use, regardless of the intensity of use. There was no additional cost savings in those using high intensity dosages. The cost-savings effect of HCQ could potentially be partially mediated through reduced damage. In addition to its well-established therapeutic potential, there may be an economic imperative for HCQ use in SLE patients.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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