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Arthritis Care Res (Hoboken). 2019 Oct 14. doi: 10.1002/acr.24092. [Epub ahead of print]

Economic evaluation of damage accrual in an international SLE inception cohort using a multi-state model approach.

Author information

1
University of Calgary, Alberta, Canada.
2
Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada.
3
MRC Biostatistics Unit, University of Cambridge, Cambridge, UK.
4
Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada.
5
Research Institute of the McGill University Health Center, Montreal, Canada.
6
Instituto Nacional de Ciencias Médicas y Nutricion, Mexico City, Mexico.
7
Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
8
Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea.
9
McGill University Health Centre, Montreal, Canada.
10
Cedars-Sinai/David Geffen School of Medicine at the University of California, Los Angeles.
11
Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA.
12
University College London, London, UK.
13
State University of New York Downstate Medical Center, Brooklyn, New York.
14
Johns Hopkins University School of Medicine, Baltimore, Maryland.
15
Arthritis 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.
16
Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC.
17
CHU de Québec -Universite Laval, Québec City, Canada.
18
Center for Rheumatology Research, Landspitali University hospital, Reykjavik, Iceland.
19
Northwestern University and Feinberg School of Medicine, Chicago, Illinois.
20
Lupus Research Unit, The Rayne Institute, St Thomas's Hospital, King's College London School of Medicine, London, UK.
21
Feinstein Institute for Medical Research, Manhasset, New York.
22
University of Alabama at Birmingham.
23
University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
24
Lund University, Lund, Sweden.
25
Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland, UK.
26
University of Amsterdam, Rheumatology & Immunology Center, Amsterdam, Noord-Holland, NL.
27
Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clinic, Barcelona, Spain.
28
BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain.
29
Emory University School of Medicine, Atlanta, Georgia.
30
University of California Los Angeles School of Medicine, La Jolla, California.
31
Istanbul University, Istanbul, Turkey.
32
Medical University of South Carolina, Charleston.
33
University of Manitoba, Winnipeg, Manitoba, Canada.
34
Copenhagen Lupus and Vasculitis Clinic, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
35
Hospital for Joint Diseases, New York University Seligman Center for Advanced Therapeutics, New York, New York.
36
Department of Rheumatology, Kantousspital, Schaffhausen, Switzerland.
37
New York University School of Medicine, New York, US.

Abstract

OBJECTIVES:

There is a paucity of data regarding healthcare costs associated with damage accrual in systemic lupus erythematosus (SLE). We describe costs associated with damage states across the disease course using multi-state modeling.

METHODS:

Patients from 33 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, disease activity, damage (SLICC/American College of Rheumatology (ACR) Damage Index [SDI]), hospitalizations, medications, dialysis, and selected procedures were collected. Ten-year cumulative costs (Canadian dollars) were estimated by multiplying annual costs associated with each SDI state by the expected state duration using a multi-state model.

RESULTS:

1687 patients participated, 88.7% female, 49.0% of Caucasian race/ethnicity, mean age at diagnosis 34.6 years (SD 13.3), and mean follow up 8.9 years (range 0.6-18.5). Annual costs were higher in those with higher SDIs (SDI ≥ 5: $22 006 2019 CDN, 95% CI $16 662, $27 350 versus SDI=0: $1833, 95% CI $1134, $2532). Similarly, 10-year cumulative costs were higher in those with higher SDIs at the beginning of the 10-year interval (SDI ≥ 5: $189 073, 95% CI $142 318, $235 827 versus SDI=0: $21 713, 95% CI $13 639, $29 788).

CONCLUSION:

Patients with the highest SDIs incur 10-year cumulative costs that are almost 9-fold higher than those with the lowest SDIs. By estimating the damage trajectory and incorporating annual costs, damage can be used to estimate future costs, critical knowledge for evaluating the cost-effectiveness of novel therapies.

PMID:
31609532
DOI:
10.1002/acr.24092

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