TY - JOUR
T1 - Remission and low disease activity are associated with lower healthcare costs
T2 - results from the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort
AU - Barber, Megan R W
AU - Ugarte-Gil, Manuel Francisco
AU - Hanly, John G
AU - Urowitz, Murray B
AU - St-Pierre, Yvan
AU - Gordon, Caroline
AU - Bae, Sang-Cheol
AU - Romero-Diaz, Juanita
AU - Sanchez-Guerrero, Jorge
AU - Bernatsky, Sasha
AU - Wallace, Daniel J
AU - Isenberg, David A
AU - Rahman, Anisur
AU - Merrill, Joan T
AU - Fortin, Paul R
AU - Gladman, Dafna D
AU - Bruce, Ian N
AU - Petri, Michelle
AU - Ginzler, Ellen M
AU - Dooley, Mary Anne
AU - Ramsey-Goldman, Rosalind
AU - Manzi, Susan
AU - Jönsen, Andreas
AU - van Vollenhoven, Ronald F
AU - Aranow, Cynthia
AU - Mackay, Meggan
AU - Ruiz-Irastorza, Guillermo
AU - Lim, S Sam
AU - Inanc, Murat
AU - Kalunian, Kenneth C
AU - Jacobsen, Søren
AU - Peschken, Christine A
AU - Kamen, Diane L
AU - Askanase, Anca
AU - Pons-Estel, Bernardo A
AU - Cardwell, Francesca S
AU - Alarcón, Graciela S
AU - Clarke, Ann E
N1 - © Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ on behalf of EULAR.
PY - 2024/9/30
Y1 - 2024/9/30
N2 - OBJECTIVES: This study aims to determine the independent impact of definitions of remission/low disease activity (LDA) on direct/indirect costs (DCs, ICs) in a multicentre inception cohort.METHODS: Patients from 31 centres in 10 countries were enrolled within 15 months of diagnosis and assessed annually. Five mutually exclusive disease activity states (DAS) were defined as (1) remission off-treatment: clinical (c) SLEDAI-2K=0, without prednisone/immunosuppressants; (2) remission on-treatment: cSLEDAI-2K=0, prednisone ≤5 mg/day and/or maintenance immunosuppressants; (3) LDA-Toronto Cohort (TC): cSLEDAI-2K≤2, without prednisone/immunosuppressants; (4) modified lupus LDA state (mLLDAS): SLEDAI-2K≤4, no activity in major organs/systems, no new activity, prednisone ≤7.5 mg/day and/or maintenance immunosuppressants and (5) active: all remaining assessments.At each assessment, patients were stratified into the most stringent DAS fulfilled and the proportion of time in a DAS since cohort entry was determined. Annual DCs/ICs (2021 Canadian dollars) were based on healthcare use and lost workforce/non-workforce productivity over the preceding year.The association between the proportion of time in a DAS and annual DC/IC was examined through multivariable random-effects linear regressions.RESULTS: 1692 patients were followed a mean of 9.7 years; 49.0% of assessments were active. Remission/LDA (per 25% increase in time in a remission/LDA state vs active) were associated with lower annual DC/IC: remission off-treatment (DC -$C1372; IC -$C2507), remission on-treatment (DC -$C973; IC -$C2604,) LDA-TC (DC -$C1158) and mLLDAS (DC -$C1040). There were no cost differences between remission/LDA states.CONCLUSIONS: Our data suggest that systemic lupus erythematosus patients who achieve remission, both off and on-therapy, and reductions in disease activity incur lower costs than those experiencing persistent disease activity.
AB - OBJECTIVES: This study aims to determine the independent impact of definitions of remission/low disease activity (LDA) on direct/indirect costs (DCs, ICs) in a multicentre inception cohort.METHODS: Patients from 31 centres in 10 countries were enrolled within 15 months of diagnosis and assessed annually. Five mutually exclusive disease activity states (DAS) were defined as (1) remission off-treatment: clinical (c) SLEDAI-2K=0, without prednisone/immunosuppressants; (2) remission on-treatment: cSLEDAI-2K=0, prednisone ≤5 mg/day and/or maintenance immunosuppressants; (3) LDA-Toronto Cohort (TC): cSLEDAI-2K≤2, without prednisone/immunosuppressants; (4) modified lupus LDA state (mLLDAS): SLEDAI-2K≤4, no activity in major organs/systems, no new activity, prednisone ≤7.5 mg/day and/or maintenance immunosuppressants and (5) active: all remaining assessments.At each assessment, patients were stratified into the most stringent DAS fulfilled and the proportion of time in a DAS since cohort entry was determined. Annual DCs/ICs (2021 Canadian dollars) were based on healthcare use and lost workforce/non-workforce productivity over the preceding year.The association between the proportion of time in a DAS and annual DC/IC was examined through multivariable random-effects linear regressions.RESULTS: 1692 patients were followed a mean of 9.7 years; 49.0% of assessments were active. Remission/LDA (per 25% increase in time in a remission/LDA state vs active) were associated with lower annual DC/IC: remission off-treatment (DC -$C1372; IC -$C2507), remission on-treatment (DC -$C973; IC -$C2604,) LDA-TC (DC -$C1158) and mLLDAS (DC -$C1040). There were no cost differences between remission/LDA states.CONCLUSIONS: Our data suggest that systemic lupus erythematosus patients who achieve remission, both off and on-therapy, and reductions in disease activity incur lower costs than those experiencing persistent disease activity.
KW - Economics
KW - Epidemiology
KW - Health services research
KW - Lupus Erythematosus, Systemic
KW - Risk Factors
KW - Severity of Illness Index
KW - Prednisone/therapeutic use
KW - Humans
KW - Middle Aged
KW - Male
KW - Remission Induction
KW - Lupus Erythematosus, Systemic/drug therapy
KW - Health Care Costs/statistics & numerical data
KW - Adult
KW - Female
KW - Immunosuppressive Agents/therapeutic use
KW - Cohort Studies
UR - http://www.scopus.com/inward/record.url?scp=85194054195&partnerID=8YFLogxK
U2 - 10.1136/ard-2024-225613
DO - 10.1136/ard-2024-225613
M3 - Journal article
C2 - 38754981
SN - 0003-4967
VL - 83
SP - 1295
EP - 1303
JO - Annals of the Rheumatic Diseases
JF - Annals of the Rheumatic Diseases
IS - 10
ER -