Association of systemic lupus erythematosus with clinical and psychosocial outcomes,health care resource utilization and expenditures: A nationally representative US-based analysis

Abstract

Background

Limited information is available on the effect of systemic lupus erythematosus (SLE) on outcomes, and healthcare resource utilization and expenditures. Such evidence can help improve care for patients with SLE.

Objectives

We examined the associations between SLE and clinical and psychosocial outcomes, healthcare resource utilization, and direct healthcare expenditures.

Methods

We conducted a retrospective US population-based cross-sectional study using the US 2017–2022 Medical Expenditure Panel Survey data. We identified patients with SLE as those who both self-reported SLE diagnosis and either reported SLE-related medication use and/or visited a rheumatologist in the survey year. We matched eight patients without SLE to each patient with SLE on survey year, age, and sex, to create a reference cohort. The outcomes we assessed included clinical outcomes, psychosocial outcomes, healthcare resource utilization, and direct healthcare expenditures. We conducted appropriate multivariable regressions to examine the associations between SLE and each outcome.

Results

Patients with SLE had significantly lower mean physical component summary (PCS) scores than those without SLE by almost five points (p < .0001). Patients with SLE reported higher odds of pain interference with activities (adjusted odds ratio (AOR) = 1.998, 95% confidence interval (CI):1.372–2.909), fair to poor physical health status (AOR = 3.141, 95% CI: 1.993–4.949), cognitive limitations (AOR = 2.665, 95% CI: 1.465–4.849), functional limitations (AOR = 2.594, 95% CI: 1.646–4.089), social limitations (AOR = 2.227, 95% CI: 1.437–3.451), and psychological distress (AOR = 2.023, 95% CI: 1.447–2.827). Likewise, patients with SLE had higher adjusted rates of outpatient visits (adjusted annualized event rate ratio (AAERR) = 2.603, p < .05), office-based visits (AAERR = 1.447, p < .05), and emergency room visits (AAERR = 1.518, p < .05). Regarding healthcare expenditures, those with SLE had significantly higher average annual healthcare expenditures than those without SLE ($18,566 vs $9,366, p < .0001), and the findings were consistent across each healthcare resource component. In the adjusted analyses, average annual healthcare expenditures for individuals with SLE were significantly higher than those without SLE ($13,664 vs $11,781, p < .05).

Conclusion

Poor physical HRQoL, increased cognitive and functional limitations, and psychological distress are common among patients with SLE. Healthcare professionals across different disciplines should address these issues during visits and provide appropriate support and resources for patients with SLE. We also found higher healthcare resource utilization and higher healthcare expenditures among patients with SLE than their non-SLE counterparts.

Keywords

Systemic lupus erythematosus medical expenditure panel survey psychosocial outcomes expenditures healthcare resource utilization

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