title: Healthcare costs of pregnancy in systemic lupus erythematosus: retrospective observational analysis from a US health claims database.
abstract: OBJECTIVE
  Systemic lupus erythematosus is a complex autoimmune disease, most frequently affecting women of childbearing age. Women with lupus are at increased risk of pregnancy complications that are exacerbated by active disease. Despite this, their use of medications and hospital resources has not been extensively studied.
  
  
  METHODS
  Retrospective analyses of the Truven Health MarketScan database (2006-2012) aimed to quantify drug and resource utilization in pregnant women with lupus, as well as the incidence of pregnancy complications in these patients. Records of women aged 12-54 were reviewed and both lupus patients and pregnancies identified. Pregnant women with lupus were matched 1:5 with either pregnant women without lupus, or non-pregnant women with lupus.
  
  
  RESULTS
  Pregnancies with lupus were associated with increased complications when compared to pregnancies without lupus. During pregnancy, the use of immunosuppressants decreased in pregnant women with lupus, as did rheumatologist visits, while the number of women not treated with any immunosuppressant increased. Pregnant women with lupus showed higher overall treatment costs than controls. However, compared to non-pregnant women with lupus, medication costs actually dropped, possibly due to the withdrawal of medications from these patients or women becoming pregnant while disease activity was low.
  
  
  CONCLUSIONS
  The large database analyses reported here revealed that pregnancies in women with lupus were associated with a higher risk of complications, higher healthcare costs, and fewer prescribed medications, including immunosuppressants, than the control groups. The increased risk of complications and decreased immunosuppressant use suggest that patients require additional guidance from physicians to give them the best chance of experiencing a safe pregnancy. Indeed, despite the recognized role active lupus plays in increasing pregnancy complications, women with lupus had fewer rheumatology visits during pregnancy, although their visits to their general practitioner/primary healthcare provider increased, highlighting the need for team-based co-ordination care between OBGYN physicians and rheumatologists.
authors.affiliation: a a Division of Rheumatology , Johns Hopkins University School of Medicine , Baltimore , MD , USA.
authors.forename: M
authors.initials: M
authors.lastname: Petri
authors.affiliation: b b Lupus Foundation of America , Washington , WA , USA.
authors.forename: R P
authors.initials: RP
authors.lastname: Daly
authors.affiliation: c c UCB Pharma , Brussels , Belgium.
authors.forename: D S
authors.initials: DS
authors.lastname: Pushparajah
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007345:Insurance Claim Review / Q000706:statistics & numerical data; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy / Q000191:economics*; D008427:Maternal Health Services / Q000191:economics / Q000706:statistics & numerical data; D008875:Middle Aged; D017059:Models, Econometric; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy / Q000191:economics*; D011256:Pregnancy Outcome / Q000453:epidemiology; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents
keywords: Healthcare costs; Pregnancy; Systemic lupus erythematosus