Abstract
1124 Economic evaluation of neuropsychiatric (NP) lupus in an international inception cohort using a multistate model approach
Lupus science & medicine, v 8(Suppl 2), pp A46-A47
04 Nov 2021
Abstract
BackgroundLittle is known about the economic burden of NP lupus. We estimated direct and indirect costs (DC, IC) associated with NP events attributed to SLE and non-SLE causes using multistate modelling.MethodsPatients fulfilling ACR classification criteria for SLE from 31 centres in 11 countries were enrolled within 15 months of diagnosis. NP events were documented annually using ACR NP definitions and attributed to SLE or non-SLE causes. At each assessment and for SLE and non-SLE events, patients were stratified into 1 of 3 NP states (no, resolved, or new/ongoing NP event). The change in NP status characterized by transition rates between states was analyzed using multistate modelling (doi:10.1002/art.41876).At each assessment, annual DC and IC were based on health resource use and lost work-force/non-work-force productivity over the preceding year. Resource use was costed using 2021 Canadian prices and lost productivity using Statistics Canada age-and-sex specific wages. Costs associated with SLE and non-SLE NP states were calculated by averaging all observations in each NP state. Multiple regressions adjusted for possible confounding of age at diagnosis, sex, race/ethnicity, disease duration, geographic region, education, and smoking on the association of annual DC and IC and NP state. 5 and 10-year cumulative costs for NP states were predicted by multiplying adjusted annual costs for each state by the expected state duration, forecasted using multistate modelling.Results1697 patients (89% female, 51% non-Caucasian race/ethnicity, mean age at enrolment 35.1 years) were followed a mean of 8.8 years. 1971 NP events occurred in 956 patients, 32% attributed to SLE. For SLE NP events, annual DC were higher in those with new/ongoing vs no events ($10,809 vs $6715) (table 1). Annual and 5-yr IC were higher in new/ongoing vs no events and new/ongoing vs resolved events (5-yr: new/ongoing vs no: $172,674 vs $136,970). For non-SLE NP events, annual IC were higher in new/ongoing vs no events, new/ongoing vs resolved events, and resolved vs no events and 5 and 10-yr IC were higher in new/ongoing vs no events (10-yr: new/ongoing vs no: $342,434 vs $279,874). For all NP states, IC exceeded DC 2.8 to 4-fold.Abstract 1124 Table 1Predicted Annual and 5 and 10-Yr Direct and Indirect Costs (in 2021 Canadian dollars) Stratified by (a) SLE and (b) Non-SLE NP States*(a) SLE NP States State 1** State 2 State 3 Difference State 1 & 2 Difference State 1 & 3 Difference State 2 & 3 Direct Costs*** 1 year 6715 9020 10809 2304 (−2439, 7048) 4093 (114, 8072) 1789 (−3769, 7346) 5 years 35567 45782 52060 10215 (−12590, 33020) 16493 (−4056, 37041) 6278 (−20421, 32976) 10 years 72307 91193 99496 18886 (−25576, 63348) 27188 (−14884, 69261) 8302 (−43120, 59725) Indirect Costs*** 1 year 24805 25133 34939 328 (−5191, 5846) 10134 (4310, 15958) 9806 (3024, 16589) 5 years 136970 138257 172674 1287 (−25270, 27844) 35704 (7705, 63702) 34417 (2800, 66033) 10 years 289343 293639 339156 4296 (−48915, 57506) 49813 (−5662, 105287) 45517 (−15111, 106145) b) Non-SLE NP States State 1 State 2 State 3 Difference State 1 & 2 Difference State 1 & 3 Difference State 2 & 3 Direct Costs*** 1 year 6401 8225 8868 1824 (−1412, 5059) 2467 (−676, 5610) 644 (−3117, 4404) 5 years 34587 41847 44002 7259 (−9411, 23930) 9414 (−6907, 25736) 2155 (−16778, 21088) 10 years 70890 83515 86262 12625 (−22051, 47301) 15372 (−18829, 49574) 2747 (−35895, 41390) Indirect Costs*** 1 year 22866 28195 34225 5330 (466, 10193) 11359 (6000, 16717) 6029 (428, 11630) 5 years 131194 151794 171979 20599 (−3717, 44915) 40785 (14979, 66591) 20186 (−6291, 46662) 10 years 279874 316701 342434 36827 (−13437, 87091) 62560 (10663, 114457) 25733 (−26882, 78348) *Values are the mean (95% CI).** State 1 = no NP event; State 2 = resolved NP event; State 3 = new/ongoing NP event.*** Adjusted for age at diagnosis, race/ethnicity, and disease duration as the other predictors (sex, region, education, and smoking) were not significant.*** Adjusted for sex, race/ethnicity, disease duration, region, education, and smoking as the other predictor (age at diagnosis) was not significant.Boldface indicates differences which are significant as the 95% CI does not include 0.ConclusionIC are 1.3-fold higher in patients with new/ongoing vs no NP events. While DC trended higher in new/ongoing events, they were not significantly higher across all NP states and times. Impaired productivity associated with ongoing and resolved NP lupus is substantial, contributing to the previously documented reduced quality of life.
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- Title
- 1124 Economic evaluation of neuropsychiatric (NP) lupus in an international inception cohort using a multistate model approach
- Creators
- Ann Clarke - University of CalgaryJohn Hanly - Queen Elizabeth II Health Sciences CentreYvan St Pierre - McGill University Health CentreCaroline Gordon - University of BirminghamSang-Cheol BaeJuanita Romero-Diaz - Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránJorge Sanchez-Guerrero - Toronto Western HospitalSasha Bernatsky - McGill University Health CentreDaniel Wallace - Cedars-Sinai Medical CenterDavid Isenberg - University College LondonAnisur Rahman - University College LondonJoan Merrill - Oklahoma Medical Research FoundationPaul tinDafna Gladman - Toronto Western HospitalMurray Urowitz - Toronto Western HospitalIan Bruce - Manchester Academic Health Science CentreMichelle Petri - Johns Hopkins MedicineEllen Ginzler - SUNY Downstate Health Sciences UniversityMary Dooley - University of North Carolina at Chapel HillRosalind Ramsey-Goldman - Northwestern UniversitySusan Manzi - University of PittsburghAndreas Jönsen - Lund UniversityGraciela Alarcón - University of Alabama at BirminghamRonald FVan Vollenhoven - University of AmsterdamCynthia Aranow - Feinstein Institute for Medical ResearchMeggan Mackay - Feinstein Institute for Medical ResearchGuillermo Ruiz-Irastorza - BioCruces Health research InstituteS LimMurat Inanc - Istanbul UniversityKenneth Kalunian - University of California, Los AngelesSoren JacobsenChristine Peschken - University of ManitobaDiane Kamen - Medical University of South CarolinaAnca Askanase - New York University Langone Orthopedic HospitalVernon Farewell - University of Cambridge
- Publication Details
- Lupus science & medicine, v 8(Suppl 2), pp A46-A47
- Publisher
- BMJ Publishing Group LTD
- Resource Type
- Abstract
- Language
- English
- Academic Unit
- General Internal Medicine
- Other Identifier
- 991021933907604721