Health Care Costs With Sustained Oral Corticosteroid Use in Systemic Lupus Erythematosus

Shirley P Huang; Maral DerSarkissian; Yuqian M Gu; Mei Sheng Duh; Min-Jung Wang; John Benson; Jensen Duy Vu; Carlyne M Averell; Christopher F Bell

doi:10.1016/j.clinthera.2023.04.013

Health Care Costs With Sustained Oral Corticosteroid Use in Systemic Lupus Erythematosus

Clin Ther. 2023 Jul;45(7):619-626. doi: 10.1016/j.clinthera.2023.04.013. Epub 2023 Jun 2.

Authors

Shirley P Huang¹, Maral DerSarkissian², Yuqian M Gu², Mei Sheng Duh², Min-Jung Wang², John Benson², Jensen Duy Vu², Carlyne M Averell¹, Christopher F Bell³

Affiliations

¹ GSK, US Value Evidence and Outcomes, Durham, North Carolina, USA.
² Analysis Group, Boston, Massachusetts, USA.
³ GSK, US Value Evidence and Outcomes, Durham, North Carolina, USA. Electronic address: christopher.f.bell@gsk.com.

PMID: 37271712
DOI: 10.1016/j.clinthera.2023.04.013

Abstract

Purpose: The goal of this study was to compare health care costs, health care resource utilization, and adverse events associated with sustained oral corticosteroid (OCS) use versus no OCS use in systemic lupus erythematosus.

Methods: This retrospective cohort study used claims data (January 1, 2006-July 31, 2019) from patients with systemic lupus erythematosus aged ≥5 years with ≥24 months of continuous enrollment. Health care costs, health care resource utilization, and OCS-related adverse events were assessed. The sustained OCS cohort (defined as ≥12 months of continuous OCS use) was divided into exposure categories based on the number of 6-month classification periods with >5 mg/d OCS (0, 1-2, or 3-4).

Findings: Of the 6234 patients in the sustained OCS use cohort, there were 1587 (25.5%) patients with 0 periods of >5 mg/d OCS use, 2087 (33.5%) patients with 1 to 2 periods of >5 mg/d OCS use, and 2560 (41.1%) patients with 3 to 4 periods of >5 mg/d OCS use; the no OCS use cohort included 7828 patients. Adjusted health care cost differences (95% CIs) were significantly greater for patients with 0, 1 to 2, and 3 to 4 periods of OCS use >5 mg/d versus the no OCS use cohort ($7774 [5426-10,223], $21,738 [18,898-25,321], and $30,119 [26,492-33,774], respectively). A higher proportion of patients in all OCS exposure categories required health care resource utilization (≥99.7% vs 93.4%) and experienced OCS-related adverse events (94.3%-96.8% vs 82.6%) versus the no OCS use cohort, with more periods of OCS use >5 mg/d associated with increased health care resource utilization and adverse events.

Implications: Sustained OCS use in systemic lupus erythematosus was associated with high economic burden, health care resource utilization, and OCS-related adverse events. These data highlight the need for health care providers to carefully consider OCS use in systemic lupus erythematosus.

Keywords: burden of disease; economic burden; oral corticosteroids; sustained corticosteroid use; systemic lupus erythematosus.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adrenal Cortex Hormones / adverse effects
Delivery of Health Care
Health Care Costs*
Humans
Lupus Erythematosus, Systemic* / drug therapy
Retrospective Studies

Substances

Adrenal Cortex Hormones