The aim of the Systemic LUpus Erythematosus Cost of Care In Europe (LUCIE) study was to evaluate the annual direct medical costs of managing adults with active autoantibody-positive disease on medication for SLE in secondary care. This paper presents the UK analyses only.
Methods
A cost-of-illness study was conducted from the perspective of the National Health Service. Health resource utilization data were retrieved over a two-year period from four centres in England and unit cost data were taken from published sources.
Results
At baseline, 86 patients were included, 38 (44.2%) had severe SLE and 48 (55.8%) had non-severe SLE. The mean (SD) SELENA-SLEDAI score was 7.7 (5.7). The mean (SD) annual direct medical cost of was estimated at £3231 (£2333) per patient and was 2.2 times higher in patients with severe SLE compared with patients with non-severe SLE (p < 0.001). Multivariate model analyses showed that renal disease involvement (p = 0.0016) and severe flares (p = 0.0001) were associated with higher annual direct costs.
Conclusions
Improvement of the overall stability of SLE and early intervention to minimize the impact of renal disease may be two approaches to mitigate the long-term direct cost of managing SLE patients in the UK.
BalluzLPhilenROrtegaL. Investigation of systemic lupus erythematosus in Nogales, Arizona. Am J Epidemiol2001; 154: 1029–1036.
2.
GovoniMCastellinoGBosiSNapoliNTrottaF. Incidence and prevalence of systemic lupus erythematosus in a district of north Italy. Lupus2006; 15: 110–113.
3.
LópezPMozoLGutiérrezCSuárezA. Epidemiology of systemic lupus erythematosus in a northern Spanish population: Gender and age influence on immunological features. Lupus2003; 12: 860–865.
4.
NightingaleALFarmerRDde VriesCS. Systemic lupus erythematosus prevalence in the UK: Methodological issues when using the General Practice Research Database to estimate frequency of chronic relapsing-remitting disease. Pharmacoepidemiol Drug Saf2007; 16: 144–151.
5.
Piette JC, Papo T, Amoura Z and Godeau P. Lupus érythémateux systémique. In: Godeau P, Herson S and Piette J-C (eds), Traité de médecine. Quatriéme ed. Paris: Flammarion Médecine-Sciences, 2004; 142–148.
6.
JohnsonAEGordonCPalmerRGBaconPA. The prevalence and incidence of systemic lupus erythematosus in Birmingham, England. Relationship to ethnicity and country of birth. Arthritis Rheum1995; 38: 551–558.
ClarkeAEPanopalisPPetriM. SLE patients with renal damage incur higher health care costs. Rheumatology (Oxford)2008; 47: 329–333.
9.
HuscherDMerkesdalSThieleKZeidlerHSchneiderMZinkA. Cost of illness in rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis and systemic lupus erythematosus in Germany. Ann Rheum Dis2006; 65: 1175–1183.
10.
LauCSMakA. The socioeconomic burden of SLE. Nat Rev Rheumatol2009; 5: 400–404.
11.
SutcliffeNClarkeAETaylorRFrostCIsenbergDA. Total costs and predictors of costs in patients with systemic lupus erythematosus. Rheumatology (Oxford)2001; 40: 37–47.
12.
WilsonECJayneDRDellowEFordhamRJ. The cost-effectiveness of mycophenolate mofetil as firstline therapy in active lupus nephritis. Rheumatology (Oxford)2007; 46: 1096–1101.
13.
ZhuTYTamLSLeeVWLeeKKLiEK. The impact of flare on disease costs of patients with systemic lupus erythematosus. Arthritis Rheum2009; 61: 1159–1167.
14.
Doria A, Amoura Z, Cervera R, et al. Annual direct medical cost of active systemic lupus erythematosus in five European countries. Ann Rheum Dis. Epub ahead of print 21 December 2012.
15.
CameronJS. Lupus nephritis. J Am Soc Nephrol1999; 10: 413–424.
16.
TanEMCohenASFriesJF. The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum1982; 25: 1271–1277.
17.
BombardierCGladmanDDUrowitzMBCaronDChangCH. Derivation of the SLEDAI. A disease activity index for lupus patients. The Committee on Prognosis Studies in SLE. Arthritis Rheum1992; 35: 630–640.
18.
LiangMHSocherSARobertsWNEsdaileJM. Measurement of systemic lupus erythematosus activity in clinical research. Arthritis Rheum1988; 31: 817–825.
19.
GladmanDDGoldsmithCHUrowitzMB. The Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index for Systemic Lupus Erythematosus International Comparison. J Rheumatol2000; 27: 373–376.
British National Formulary No. 61. BNF 2011, http://bnf.org/bnf/ (accessed 25 April 2011).
22.
BuyonJPPetriMAKimMY. The effect of combined estrogen and progesterone hormone replacement therapy on disease activity in systemic lupus erythematosus: A randomized trial. Ann Intern Med2005; 142 (12 Pt 1): 953–962.
23.
PetriMBuyonJKimM. Classification and definition of major flares in SLE clinical trials. Lupus1999; 8: 685–691.
24.
PetriMKimMYKalunianKC. Combined oral contraceptives in women with systemic lupus erythematosus. N Engl J Med2005; 353: 2550–2558.
25.
SlawskyKAFernandesAWFusfeldLManziSGossTF. A structured literature review of the direct costs of adult systemic lupus erythematosus in the US. Arthritis Care Res (Hoboken)2011; 63: 1224–1232.
26.
ZhuTYTamLSLiEK. Cost-of-illness studies in systemic lupus erythematosus: A systematic review. Arthritis Care Res (Hoboken)2011; 63: 751–760.
27.
ClarkeAEPetriMAManziS. An international perspective on the well being and health care costs for patients with systemic lupus erythematosus. Tri-Nation Study Group. J Rheumatol1999; 26: 1500–1511.
28.
ClarkeAEPenrodJSt PierreY. Underestimating the value of women: Assessing the indirect costs of women with systemic lupus erythematosus. Tri-Nation Study Group. J Rheumatol2000; 27: 2597–2604.
29.
ClarkeAEPetriMManziS. The systemic lupus erythematosus Tri-nation Study: Absence of a link between health resource use and health outcome. Rheumatology (Oxford)2004; 43: 1016–1024.
30.
BexeliusCWachtmeisterKSkarePJönssonLVollenhovenRv. Drivers of cost and health-related quality of life in patients with systemic lupus erythematosus (SLE): A Swedish nationwide study based on patient reports. Lupus2013; 22: 793–801.
