Journal article
Remission and low disease activity are associated with lower healthcare costs: results from the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort
Annals of the rheumatic diseases, v 83(10), pp 1295-1303
01 Oct 2024
PMID: 38754981
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
ObjectivesThis study aims to determine the independent impact of definitions of remission/low disease activity (LDA) on direct/indirect costs (DCs, ICs) in a multicentre inception cohort.MethodsPatients from 31 centres in 10 countries were enrolled within 15 months of diagnosis and assessed annually. Five mutually exclusive disease activity states (DAS) were defined as (1) remission off-treatment: clinical (c) SLEDAI-2K=0, without prednisone/immunosuppressants; (2) remission on-treatment: cSLEDAI-2K=0, prednisone ≤5 mg/day and/or maintenance immunosuppressants; (3) LDA-Toronto Cohort (TC): cSLEDAI-2K≤2, without prednisone/immunosuppressants; (4) modified lupus LDA state (mLLDAS): SLEDAI-2K≤4, no activity in major organs/systems, no new activity, prednisone ≤7.5 mg/day and/or maintenance immunosuppressants and (5) active: all remaining assessments.At each assessment, patients were stratified into the most stringent DAS fulfilled and the proportion of time in a DAS since cohort entry was determined. Annual DCs/ICs (2021 Canadian dollars) were based on healthcare use and lost workforce/non-workforce productivity over the preceding year.The association between the proportion of time in a DAS and annual DC/IC was examined through multivariable random-effects linear regressions.Results1692 patients were followed a mean of 9.7 years; 49.0% of assessments were active. Remission/LDA (per 25% increase in time in a remission/LDA state vs active) were associated with lower annual DC/IC: remission off-treatment (DC −$C1372; IC −$C2507), remission on-treatment (DC −$C973; IC −$C2604,) LDA-TC (DC −$C1158) and mLLDAS (DC −$C1040). There were no cost differences between remission/LDA states.ConclusionsOur data suggest that systemic lupus erythematosus patients who achieve remission, both off and on-therapy, and reductions in disease activity incur lower costs than those experiencing persistent disease activity.
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Details
- Title
- Remission and low disease activity are associated with lower healthcare costs: results from the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort
- Creators
- Megan R W Barber - University of CalgaryManuel Francisco Ugarte-Gil - Universidad Científica del SurJohn G Hanly - Queen Elizabeth II Health Sciences CentreMurray B Urowitz - Toronto Western HospitalYvan St-Pierre - McGill University Health CentreCaroline Gordon - University of BirminghamSang-Cheol Bae - Hanyang Institute of Bioscience and Biotechnology, Seoul, Korea (the Republic of)Juanita Romero-Diaz - Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránJorge Sanchez-Guerrero - Mount Sinai HospitalSasha Bernatsky - McGill University Health CentreDaniel J Wallace - Cedars-Sinai Medical CenterDavid A Isenberg - University College LondonAnisur Rahman - University College LondonJoan T Merrill - Oklahoma Medical Research FoundationPaul R Fortin - Université LavalDafna D Gladman - University of TorontoIan N Bruce - University of ManchesterMichelle Petri - Johns Hopkins MedicineEllen M Ginzler - SUNY Downstate Health Sciences UniversityMary Anne Dooley - University of North Carolina at Chapel HillRosalind Ramsey-Goldman - Northwestern UniversitySusan Manzi - Allegheny Health NetworkAndreas Jönsen - Lund UniversityRonald F van Vollenhoven - University of AmsterdamCynthia Aranow - Feinstein Institute for Medical ResearchMeggan Mackay - Feinstein Institute for Medical ResearchGuillermo Ruiz-Irastorza - BioCruces Health research InstituteS Sam Lim - Emory UniversityMurat Inanc - Istanbul UniversityKenneth C Kalunian - University of California San DiegoSøren Jacobsen - RigshospitaletChristine A Peschken - University of ManitobaDiane L Kamen - Medical University of South CarolinaAnca Askanase - Columbia UniversityBernardo A Pons-Estel - Hospital Provincial de RosarioFrancesca S Cardwell - University of WaterlooGraciela S Alarcón - University of Alabama at BirminghamAnn E Clarke - University of Calgary
- Publication Details
- Annals of the rheumatic diseases, v 83(10), pp 1295-1303
- Publisher
- BMJ Publishing Group Ltd and European League Against Rheumatism
- Number of pages
- 9
- Grant note
- NIHR203308 / Manchester Biomedical Research Centre (http://dx.doi.org/10.13039/100014653) A05990 / Novo Nordisk Fonden (http://dx.doi.org/10.13039/501100009708) LUPUS UK (http://dx.doi.org/10.13039/501100018817) IT 1512-22 / Department of Education of the Basque Government Birmingham NIHR/Wellcome Trust Clinical Research Facility NRF-2021R1A6A1A03038899 / National Research Foundation of Korea (http://dx.doi.org/10.13039/501100003725) 1U54TR001353; AR043727; AR069572; K24 AR002213; K24-AR-02318; P60AR064464; R01 AR046588; RR00046; UL-1RR-025741 / NIH grant Tier 1 Canada Research Chair on Systemic Autoimmune Rheumatic Diseases Arthritis Society Chair in Rheumatic Diseases A1028 / Gigtforeningen (http://dx.doi.org/10.13039/100008368)
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- General Internal Medicine
- Web of Science ID
- WOS:001224539200001
- Scopus ID
- 2-s2.0-85194054195
- Other Identifier
- 991021933898504721
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- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Rheumatology