title: A longitudinal analysis of costs associated with change in disease activity in systemic lupus erythematosus.
abstract: OBJECTIVE
  To estimate the economic consequences of changes in disease activity on healthcare resource utilization (HRU) and costs.
  
  
  METHODS
  A retrospective longitudinal study of systemic lupus erythematosus (SLE) patients receiving care in a regional integrated health delivery system in the US from 01/2004 through 03/2011 was conducted using electronic health records, medical chart reviews, and claims. Eligible patients were ≥18 years old, with ≥1 rheumatologist-confirmed SLE diagnosis and ≥1 eligible rheumatology encounter. Patients were continuously enrolled ≥90 days before and ≥30 days after the encounters. Charts were manually reviewed to estimate SLEDAI scores. Average unit costs of each medical procedure, facility use, and prescription were estimated from a payer perspective (2011 USD) using a managed care claims database. HRU and costs were calculated for the 30-day period surrounding every SLEDAI score date (10 days before and 19 after). Relationships between HRU/costs and SLEDAI scores were estimated using mixed-effect models.
  
  
  RESULTS
  Overall, 178 SLE patients were included; mean age was 50.6 years, 91% were female, and 95.5% Caucasian. Patients had a total of 1343 encounters with SLEDAI scores over an average period of 1035 days. Reductions of SLEDAI scores were associated with reductions in HRU and costs. SLEDAI score reductions of 4-points were associated with reductions of 10% HRU and 14% costs over a 30-day period; reductions of 8-points had associated reductions of 19% HRU and 26% costs; and reductions of 10-points had associated reductions of 23% HRU and 31% costs. Annualized, changes in SLEDAI scores are associated with changes of $2485 (SLEDAI score change: 10-6), $4624 (10-2), and $5579 (10-0), respectively.
  
  
  CONCLUSIONS
  Reductions in disease activity were associated with substantial reductions of HRU and costs.
  
  
  CONCLUSIONS
  Only short-term effects of disease activity change were investigated, disregarding other potential benefits of low disease activity on long-term organ damage prevention or comorbidities.
authors: GlaxoSmithKline, Durham, NC, USA.
authors: Hong
authors: H
authors: Kan
authors: Annie
authors: A
authors: Guerin
authors: Michael S
authors: MS
authors: Kaminsky
authors: Andrew P
authors: AP
authors: Yu
authors: Eric Q
authors: EQ
authors: Wu
authors: Alfred
authors: A
authors: Denio
authors: Jhingran
authors: J
authors: Priti
authors: Siva
authors: S
authors: Narayanan
authors: Charles
authors: C
authors: Molta
mesh_terms: D000293:Adolescent; D000328:Adult; D003365:Costs and Cost Analysis; D005260:Female; D006296:Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D006801:Humans; D007345:Insurance Claim Review; D008137:Longitudinal Studies; D008180:Lupus Erythematosus, Systemic / Q000191:economics / Q000473:pathology*; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D011792:Quebec; D012189:Retrospective Studies; D012720:Severity of Illness Index; D055815:Young Adult