POS0177-PARE COST OF ILLNESS IN SYSTEMIC LUPUS ERYTHEMATOSUS- A MULTICENTRIC ANALYSIS FROM THE SLE SPECIAL INTEREST GROUP (SIG) OF THE INDIAN RHEUMATOLOGY ASSOCIATION (IRA)
Authors: V. Shobha, A. Jain, A. Shukla, N. V, N. Patel, M. Doshi, S. Kayidhi, S. Ramteke, R. Subramanian, M. Mahabaleshwar, A. Goel, C. Gera, S. Nallasivan, S. Selvam, A. Aggarwal
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> SLE imposes a substantial economic burden on patients, including medical and non-medical costs. We performed 'cost-of-illness' analysis in Indian SLE patients encompassing all expenses incurred in their treatment. <h3>Objectives:</h3> To assess the economic impact of SLE on patients and study its relationship with disease and non-disease variables. In addition, frequency and determinants of catastrophic healthcare expenditure were also assessed. <h3>Methods:</h3> This is a cross-sectional questionnaire-based survey carried out by the members of the Lupus Special Interest Group (SIG) of the Indian Rheumatology Association. SLE patients diagnosed using SLICC-2012 criteria and under treatment for at least one year were invited to participate. Patients with overlap syndromes were excluded. A questionnaire was collectively developed including a pilot run to understand the economic impact on SLE patients and was administered by trained research staff in the local language. Information gathered was self-reported without a formal record review. The socio-demographic profile was recorded as per modified Kuppuswamy 2020 scale(SES). Direct costs included medical costs (consultation, hospitalisations, lab, and medications cost) and indirect costs included travel, and food expenses (90.87INR=1 EURO). Catastrophic expenditure (CExp) was defined as more than 20% of annual income and analysed for various sociodemographic and clinical variables. Disease activity and damage were assessed using SLEDAI and SLICC damage index respectively where available. Their productivity was assessed using iMTA Productivity Cost Questionnaire (PCQ) with the developer's consent. <h3>Results:</h3> We included 350 SLE patients (mean age 32.4±11.14 years, 92% women and 5.14% (n=18) children) from 11 rheumatology centres (2, Government Medical teaching Institutes, 5 private teaching colleges and 4 private medical set-ups) (Figure 1a). The mean duration of follow-up with respective treating rheumatologist was 47.31±55.02months. Renal involvement was noted in 151(43.1%), while neurological domain was affected in 67(19.1%). Majority of patients were prescribed hydroxychloroquine (308/350(88%)), cyclophosphamide was administered for 4.5%(n=16) during the course of illness. Rituximab prescription was noted in 7.14%(n=25) patients. Figure 1c provides an overview of the cohort and the distribution of expenses incurred is depicted in Figure 1b. The mean annual cost of illness was INR 57541.18±99070.34, and the expenses incurred for medications alone amounted to INR 32078.3±34550.67 per annum. Overall, half of patients (n=175) were spending more than 10% of their income for treatment annually, above 20% expenditure by 108 (30.85%) patients. Patients spending more than 20% of their annual income on treatment were residing in rural areas, belonging to lower income strata as determined by recipients of BPL cards, and Kuppuswamy SES as represented in Table 1. The overall annual hospitalisation rate for the cohort was 100/350 (28.57%), mean cost per hospitalisation being INR 83784±152053.4. Any one comorbidities were noted in 154(44%) patients. The commonest comorbidity being hypertension (19.1%), followed by hypothyroidism(18.8%). The annual cost of treatment of comorbidities was INR 5563.73±8222.74. Almost 3/4th [262(74.8%)] of patients were self-financing their illness, and less than 5% were using medical insurance. Only 67(19.14%) patients were currently employed and 12(17.91%) needed to absent themselves due to their illness. Those with higher SDI &gt;1 [102(29.1%)], were older, had longer duration of illness, renal and neuropsychiatric manifestations and belonged to lower socioeconomic strata. This group also had higher annual expenditure and hospitalisation costs.(Table 1) <h3>Conclusion:</h3> About one third of Indian SLE patients spend more than 20% of the family income for their treatment which is out-of -pocket in about three-fourths. Cost of medications form the majority component. Those with higher damage have higher annual expenditure and hospitalisation related expenses. <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>