Review: Lupus Nephritis Leads to Spike in Health Care Costs, Utilization

Patients with lupus nephritis (LN) have substantially higher healthcare costs and utilization compared to patients with systemic lupus erythematosus (SLE) without LN, or healthy controls, according to a new literature review.

The study, published in the journal Rheumatology and Therapy, offers a big-picture look at the ways in which a diagnosis of LN can affect a patient’s healthcare trajectory. The report is based on 22 studies and 28 articles published through December 2019.

Corresponding author Kerry Gairy, MSc, of GlaxoSmithKline, and colleagues, explained that between one-third and one-half (31-48%) of patients with SLE also have a diagnosis of LN, and in as many as one-third of those cases, LN is already present upon diagnosis with SLE.

“Patients with LN have a higher risk of death compared with the general population, a risk that increases further if LN progresses to end-stage kidney disease (ESKD),” Gairy and colleagues wrote.

Up to 28% of patients with LN will go on to develop ESKD, they added.

Existing literature has shown that patients with SLE have significantly higher healthcare costs compared to patients without the condition. Yet, the investigators said there has not yet been much evidence regarding how those healthcare costs vary among the subset of patients with LN. Gairy and colleagues hoped to better ascertain the direct and indirect healthcare costs associated with LN, and also understand how a diagnosis of LN would affect healthcare utilization.

Of the 22 studies identified by the authors, 19 dealt with healthcare costs and 13 dealt with healthcare resource utilization. Most of the studies (13) were from North America.

The studies varied in dollar amounts, but their results were clear: patients with LN had higher healthcare costs (both direct and indirect) compared to patients with non-renal SLE and healthy controls. LN also led to higher healthcare utilization, including more inpatient and outpatient hospital visits, more emergency department visits, and longer stays in the hospital.

In terms of cost, one study found patients with LN had annual direct healthcare costs of more than $58,000, compared to just $11,527 for healthy controls. Another study found patients with LN had annual costs of $30,652, on average, while patients with SLE but not LN had annual costs of $12,029. Those same trends held true when indirect costs like work absenteeism, short-term disability, and lost productivity were added in.

In terms of healthcare resource utilization, LN also led to an upward shift.

“The proportion of patients reporting inpatient hospitalizations increased by 1.3–2.2 times in patients with LN compared with patients with SLE without LN and by 3.7–5.3 times compared with matched control patients without SLE,” Gairy and colleagues reported.

One data point missing from the review, the authors said, was the cost associated with renal flares. None of the studies reviewed described the cost of renal flares, something the investigators said should be remedied with future studies. They hypothesized that flares would likely result in a period of increased healthcare utilization, though they said that could potentially be mitigated by the use of therapeutics.

“As new interventions emerge for the treatment of active LN, greater delineation of these costs at the patient level will be critical to demonstrating their economic value,” the authors said.

Reference

Thompson JC, Mahajan A, Scott DA, Gairy K. The Economic Burden of Lupus Nephritis: A Systematic Literature Review [published online ahead of print, 2021 Nov 3]. Rheumatol Ther. 2021;10.1007/s40744-021-00368-y. doi:10.1007/s40744-021-00368-y