FRI0318 Health care resource utilisation (HCRU) and cost analyses of systemic lupus erythematosus (SLE) as a function of disease severity: analysis of real-world claims data from a german sickness fund
Authors: E.R. Hammond, H. Friedel, E. Garal-Pantaler, M. Pignot, E. Velthuis, X. Wang, H. Nab, B. Desta, A. Schwarting
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> SLE is a severe, chronic autoimmune disease of the connective tissue involving multiple organ systems. Understanding the economic burden of SLE in the context of disease severity is important when considering new therapeutic options. <h3>Objectives</h3> HCRU and costs associated with SLE were examined retrospectively using anonymized data from a German Sickness Fund database. <h3>Methods</h3> Real-world claims for adult (≥18 years old) patients (pts) with SLE from a German Sickness Fund database of company health insurance schemes were analysed. HCRU and costs were assessed annually for 2009–2014 for pts diagnosed with <sup>SLE in 2009</sup> and validated using repeated SLE-related claims, co-diagnosis codes, laboratory tests, prescription treatment, and the diagnosing physician's specialty. Pts had to have data available for 2009 and ≥3 years before the index quarter in 2009. HCRU and costs for SLE cases were compared with those of controls matched (4:1) by age, sex, and baseline Charlson Comorbidity Index (CCI). Continuous outcomes were compared with a nonparametric test (e.g., Wilcoxon–Mann-Whitney) because most outcome distributions were positively skewed. <h3>Results</h3> Of the 3,290,701 persons with data available for 2009 and ≥3 years prior, 1228 had an SLE diagnosis in 2009. SLE prevalence steadily increased from 37.32/100,000 (incidence: 5.96/100,000 per year) in 2009 to 47.36/100,000 in 2014. The final sample comprised 1,160 SLE-confirmed pts (mean age: 52 years; females: 84%; baseline CCI range: 1–13). Most (85%) pts were diagnosed with SLE before 2009 SLE disease severity at baseline was classified as mild for 148, moderate for 484, and severe for 528 pts using a combination of International Classification of Diseases-10 GM and medication/procedures codes. Compared with matched controls, SLE pts, overall and those with moderate and severe disease, had significantly greater mean annual medical costs in 2009 (all SLE: €6895 vs. €3,692; moderate SLE: €4867 vs. €3,380; severe SLE: €10 001 vs. €4,239; p&lt;0.0001 for each comparison) and each year thereafter. Mean costs, total number of hospital days, numbers of outpatient visits, hospital stays, and outpatient prescriptions, and other benefits were significantly greater for all pts with SLE and for those with moderate and severe disease vs. matched controls. For example, for pts with severe SLE vs. controls, mean costs for hospital stays, outpatient prescriptions, and other benefits were €4335 vs. €1,414, €2582 vs. €1,087, and €1068 vs. €691, respectively, in 2009. <h3>Conclusions</h3> In Germany, the economic burden of moderate and severe SLE was greater than that of sociodemographic- and morbidity-adjusted controls between 2009 and 2014. Pts with SLE incurred greater HCRU and total annual medical costs vs. matched controls. HCRU increased with increasing SLE disease severity, with the greatest burden among pts with severe disease. New treatments could reduce HCRU and future costs. <h3>Disclosure of Interest</h3> E. Hammond Employee of: AstraZeneca, H. Friedel: None declared, E. Garal-Pantaler: None declared, M. Pignot: None declared, E. Velthuis: None declared, X. Wang Employee of: AstraZeneca, H. Nab Employee of: AstraZeneca, B. Desta Employee of: AstraZeneca, A. Schwarting: None declared