Patients with cutaneous lupus erythematosus (CLE) and depression spend twice as much each year on healthcare-related costs than patients with CLE without depression, according to the results of a recent study (Ogunsanya ME, et al. Lupus. 2018;27:1107-1115).
Motolani Ogunsanya, PhD, Assistant Professor, Department of Pharmacy: Clinical and Administrative Sciences, College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma City, and colleagues reported that approximately 30% of patients with CLE have comorbid depression, and estimated that the increase in healthcare expenditures costs patients with CLE in the United States $13.7 billion annually.
The researchers observed that previous studies of dermatologic diseases have shown a much higher prevalence of depression in patients with CLE—in some cases double or triple that of the general population. They wanted to determine how this influenced healthcare expenditures among patients with the condition, which had not been previously studied. They noted that the economic impact of CLE is not yet known because previous studies have focused on patients with systemic lupus erythematosus.
“There is, therefore, a need to better understand the drivers of high health care expenditures among individuals with CLE, particularly those with comorbid depression. This understanding could inform the development of interventions and programs to reduce the economic burden in this population,” Dr Ogunsanya and colleagues explained.
To assess the prevalence of CLE and those with CLE and depression among the general population, the researchers used Medical Expenditure Panel Survey (MEPS) data for the year 2014. MEPS collects data on medical conditions, payment sources, insurance coverage, healthcare expenditures, and healthcare utilization for the United States’ noninstitutionalized civilian population. This information was used along with International Classification of Diseases, 9th Revision, clinical modification and clinical classification codes to determine the proportion of the US population with CLE and depression. The MEPS data were then weighted to provide a representation of the entire US population.
According to the weighted results, Dr Ogunsanya and colleagues determined that 0.7% (approximately 2.33 million) individuals had been previously diagnosed with CLE, and 29.7% of them also had depression. More important, the study results showed that the mean yearly total healthcare expenditures among those with CLE and depression was twofold greater than those with CLE alone ($19,854 vs $9735).
Patients with CLE and comorbid depression also had greater healthcare utilization than patients with CLE alone. Those with CLE and depression had more inpatient visits (0.51 vs 0.15, respectively; P <.001), outpatient hospitalizations (4.16 vs 1.61, respectively), office visits (21.17 vs 15.31, respectively), emergency department visits (0.66 vs 0.29, respectively), and prescriptions (44.85 vs 24.57, respectively) than those with CLE and no depression.
In an adjusted analysis, which took into account covariates such as sex, health self-perception, and comorbidities, patients with CLE and depression had 13% more inpatient visits, 17% more emergency department visits, and 115% more prescriptions than those with CLE alone. This translated into an annual healthcare expenditure cost increase of 81% for patients with CLE and depression.
The researchers noted that their study was limited because its cross-sectional design cannot imply causality between CLE with depression and an increase in healthcare expenditures. In addition, they cited the possibility of recall bias because the “disease condition was based on self-report.” However, because the analysis did not include patients’ productivity loss resulting from their disease, the final results may actually underestimate the economic burden on patients with CLE, especially those with comorbid depression.
“Depression is highly prevalent among patients with CLE and is associated with significantly high healthcare expenditure. By treating depression early in this group of patients, we not only can improve their health and well-being, but also reduce the cost associated with CLE management,” Dr Ogunsanya and colleagues concluded.