Glucocorticoid Use in Patients With Systemic Lupus Erythematosus: Association Between Dose and Health Care Utilization and Costs.
OBJECTIVE
To investigate the determinants of health care utilization and costs with use of glucocorticoid (GC) drugs among adult systemic lupus erythematosus (SLE) patients.


METHODS
This cross-sectional study analyzed established SLE patients identified by International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes from a large US insurance claims database in 2007-2011. Five patient groups were defined by their oral GC use during a 1-year period: non-GC users, <60 days of GC use, and ≥60 days of GC use in low dosage (≤7.5 mg/day), medium dosage (>7.5 to ≤15 mg/day), or higher dosage (>15 mg/day). Annual health care utilization and costs were compared across these groups. Incremental costs of GC groups, calculated as the difference in total health care costs compared with those of the non-GC group, were estimated from multivariable regressions adjusting for demographic/clinical characteristics and stratified by concomitant immunosuppressant use.


RESULTS
A total of 50,230 SLE patients were identified (52% non-GC users, 20% <60 days of GC use, and 10% low dose, 10% medium dose, and 8% higher dose of ≥60 days of GC use). GC users had higher health care utilization and costs. Incremental costs were significant (all P < 0.01) for medium-dose ($5,319 and $6,913) and higher-dose ($12,517 and $15,019) GC groups, regardless of concomitant immunosuppressant use. The incremental costs for the low-dose GC group with concomitant immunosuppressants ($1,285; P = 0.04) were smaller than the incremental costs for the low-dose GC group without concomitant immunosuppressants ($2,514; P < 0.01).


CONCLUSIONS
GC use, especially at higher doses, was associated with higher health care utilization and costs. Findings in users with concomitant immunosuppressants suggest that therapies with a GC-sparing effect may be associated with lower economic burden in SLE treatment.
Biogen, Cambridge, Massachusetts.
Shih-Yin
SY
Chen
Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea, and Brigham and Women's Hospital and VA Healthcare System, Boston, Massachusetts.
Chan-Bum
CB
Choi
Evidera, Lexington, Massachusetts.
Qian
Q
Li
Biogen, Cambridge, Massachusetts.
Wei-Shi
WS
Yeh
Evidera, Lexington, Massachusetts.
Yuan-Chi
YC
Lee
Biogen, Cambridge, Massachusetts.
Amy H
AH
Kao
Harvard Medical School, Boston, Massachusetts.
Matthew H
MH
Liang
D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D005938:Glucocorticoids / Q000191:economics* / Q000627:therapeutic use*; D017048:Health Care Costs; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy* / Q000191:economics; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care
D005938:Glucocorticoids