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Long-Term Steroid Use for Lupus Increases Healthcare Costs and Utilization

Rheumatology Practice Management October 2018 Vol 6 No 5 - Lupus
Tony Mansolillo

 

According to the results of a recent study, long-term corticosteroid treatment has been associated with significantly higher overall healthcare utilization and costs in patients with systemic lupus erythematosus (SLE) who received high- and medium-dose regimens versus those with SLE who received long-term, low-dose regimens or who did not initiate corticosteroid treatment. Researchers in this study also reported that for each 1-mg increase in the average daily dose of corticosteroid treatment, patients with SLE had an increased cost ratio of 1.07 in total healthcare expenditures by year 3 of treatment (95% confidence interval, 1.062-1.074; P <.0001) (Kabadi S, et al. Lupus. 2018;27:1799-1809).

Many studies have evaluated the cost of treatment for patients with SLE, but, as the study investigators noted, “Although the clinical burden and toxicity of CSs [corticosteroids] are well established in the literature, none of these studies have evaluated the HCRU [healthcare resource utilization] and costs among SLE patients newly initiating oral CS therapy and receiving long-term high-dose, medium-dose, or no CSs versus low-dose oral CSs.”

To examine this population of patients with SLE receiving corticosteroid treatment, Shaum Kabadi, PhD, Global Director of Real World Evidence, AstraZeneca, Gaithersburg, MD, and colleagues conducted an observational, retrospective cohort study of 18,618 patients using the IQVIA PharMetrics Plus Health Plan Claims Database, which contains pharmacy and medical claims of >150 million health plan patients across the United States. Dr Kabadi and colleagues identified patients aged ≥18 years with ≥2 non–same-day medical claims that contained an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis of SLE from January 1, 2008, to June 30, 2013. The study patients were then divided into corticosteroid treatment groups by average daily dose (low-dose ≤5 mg/day; medium-dose 6 mg-20 mg/day; high-dose >20 mg/day) and evaluated over a 24-month period after the initiation of corticosteroid treatment.

Previous studies used “relatively older data” to evaluate the healthcare-related costs associated with corticosteroid use in patients with SLE, according to Dr Kabadi and colleagues, who noted that, “US payers are interested in recent data. As CSs are commonly prescribed in SLE patients and many patients take them chronically, it is important to generate evidence on the current clinical and economic burden associated with long-term CS use.”

The study analysis showed that patients with SLE who initiated high-dose corticosteroid treatment had significantly higher average annual healthcare costs compared with those in the low-dose corticosteroid group ($60,366 vs $18,777; P <.0001) by the third year of follow-up. This translates into 2.8-times higher average annual healthcare costs for the high-dose corticosteroid group, whereas the medium-dose group was at 1.7 times the annual cost of the low-dose group ($31,095 per year for the medium-dose group; P <.0001) by year 3. Patients in the nonsteroid group had mean all-cause total healthcare costs of $13,632, a significantly lower amount when compared with the low-dose steroid group (P <.0001).

Dr Kabadi and colleagues noted that their study was limited by the fact that administrative claims data are not designed for conducting research, and therefore no inferences can be made regarding cause and effect. Second, the study focused on patients who received continuous treatment and may exclude those who have different observation and treatment patterns. In addition, they acknowledged that medical billing codes used to determine a diagnosis of SLE are subject to nonclinical influences.

Clinical Implications

The investigators reiterated previous recommendations regarding the use of corticosteroids to treat symptoms of SLE, including minimizing exposure to these drugs and evaluating patients for preexisting comorbidities before initiating their use to evaluate the risk for any corticosteroid-related adverse events.

“Patients with SLE receiving CSs require greater resource use for disease and medication management,” Dr Kabadi and colleagues wrote in their analysis. “Minimizing the daily steroid use of SLE patients while concomitantly controlling their disease activity may reduce the looming economic burden associated with [corticosteroid] use.”

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