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1124 Economic evaluation of neuropsychiatric (NP) lupus in an international inception cohort using a multistate model approach
  1. Ann E Clarke1,
  2. John G Hanly2,
  3. Yvan St Pierre3,
  4. Caroline Gordon4,
  5. Sang-Cheol Bae5,
  6. Juanita Romero-Diaz6,
  7. Jorge Sanchez-Guerrero7,
  8. Sasha Bernatsky8,
  9. Daniel J Wallace9,
  10. David A Isenberg10,
  11. Anisur Rahman10,
  12. Joan T Merrill11,
  13. Paul R Fortin12,
  14. Dafna D Gladman7,
  15. Murray B Urowitz7,
  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. Vernon Farewell31
  1. 1University of Calgary, Alberta, Canada
  2. 2Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
  3. 3Research Institute of the McGill University Health Center, Montreal, Canada
  4. 4Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
  5. 5Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
  6. 6Instituto Nacional de Ciencias Médicas y Nutricion, Mexico City, Mexico
  7. 7Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
  8. 8McGill University Health Centre, Montreal, Canada
  9. 9Cedars-Sinai/David Geffen School of Medicine at the University of California, Los Angeles, California, USA
  10. 10University College London, London, UK
  11. 11Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA
  12. 12CHU de Québec –Universite 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
  31. 31University of Cambridge, Cambridge, UK


Background Little is known about the economic burden of NP lupus. We estimated direct and indirect costs (DC, IC) associated with NP events attributed to SLE and non-SLE causes using multistate modelling.

Methods Patients fulfilling ACR classification criteria for SLE from 31 centres in 11 countries were enrolled within 15 months of diagnosis. NP events were documented annually using ACR NP definitions and attributed to SLE or non-SLE causes. At each assessment and for SLE and non-SLE events, patients were stratified into 1 of 3 NP states (no, resolved, or new/ongoing NP event). The change in NP status characterized by transition rates between states was analyzed using multistate modelling (doi:10.1002/art.41876).

At each assessment, annual DC and IC were based on health resource use and lost work-force/non-work-force productivity over the preceding year. Resource use was costed using 2021 Canadian prices and lost productivity using Statistics Canada age-and-sex specific wages. Costs associated with SLE and non-SLE NP states were calculated by averaging all observations in each NP state. Multiple regressions adjusted for possible confounding of age at diagnosis, sex, race/ethnicity, disease duration, geographic region, education, and smoking on the association of annual DC and IC and NP state. 5 and 10-year cumulative costs for NP states were predicted by multiplying adjusted annual costs for each state by the expected state duration, forecasted using multistate modelling.

Results 1697 patients (89% female, 51% non-Caucasian race/ethnicity, mean age at enrolment 35.1 years) were followed a mean of 8.8 years. 1971 NP events occurred in 956 patients, 32% attributed to SLE. For SLE NP events, annual DC were higher in those with new/ongoing vs no events ($10,809 vs $6715) (table 1). Annual and 5-yr IC were higher in new/ongoing vs no events and new/ongoing vs resolved events (5-yr: new/ongoing vs no: $172,674 vs $136,970). For non-SLE NP events, annual IC were higher in new/ongoing vs no events, new/ongoing vs resolved events, and resolved vs no events and 5 and 10-yr IC were higher in new/ongoing vs no events (10-yr: new/ongoing vs no: $342,434 vs $279,874). For all NP states, IC exceeded DC 2.8 to 4-fold.

Abstract 1124 Table 1

Predicted Annual and 5 and 10-Yr Direct and Indirect Costs (in 2021 Canadian dollars) Stratified by (a) SLE and (b) Non-SLE NP States*

Conclusion IC are 1.3-fold higher in patients with new/ongoing vs no NP events. While DC trended higher in new/ongoing events, they were not significantly higher across all NP states and times. Impaired productivity associated with ongoing and resolved NP lupus is substantial, contributing to the previously documented reduced quality of life.

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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