Lupus Leads to Low Work Productivity and High Health Care Costs

Article ID: 545494

Released: 22-Oct-2008 1:00 PM EDT

Source Newsroom: American College of Rheumatology (ACR)

Newswise — Both direct health care costs and costs associated with decreased work productivity are substantial for people with systemic lupus erythematosus, according to research presented this week at the American College of Rheumatology Annual Scientific Meeting in San Francisco, Calif.

Systemic lupus erythematosus (also called SLE or lupus) is a chronic inflammatory disease that can affect the skin, joints, kidneys, lungs, nervous system, and/or other organs of the body. The most common symptoms include skin rashes and arthritis, often accompanied by fatigue and fever. The clinical course of SLE varies from mild to severe, and typically involves alternating periods of remission and relapse. Lupus affects an estimated 161,000 to 322,000 U.S. adults in the United States. Researchers reviewed data derived from 812 patients with lupus from the United States who participated in annual structured telephone interviews to estimate their health care costs and work productivity. The majority of participants were white females, with an average age of 48 years, who had their disease for an average of 13.7 years.

Participants provided information regarding their health care resource utilization, employment, demographics, lupus symptoms and activity, health status and medications. Cost estimates were then derived for both direct health care costs (including costs for acute and chronic care hospitalizations, emergency department services, outpatient services provided by physicians and other health professionals, outpatient surgical procedures, dialysis and medications) and productivity costs related to changes in hours of work productivity since diagnosis of lupus. These costs were compared to those of members of the U.S. population who do not have lupus. Researchers found that the average annual direct health care cost of patients with lupus was $12,643. Acute care hospital admissions accounted for almost half of all direct health care costs; one-quarter of costs were due to medications; and more than ten percent of costs resulted from outpatient visits to physicians. In contrast, national average per capita expenditures for these types of direct health care costs was $4,482 in 2004.

Researchers also determined that the mean annual productivity costs (lost hours of productive work) for participants of employment age (between the ages of 18 and 65) was $8,659. Thus, the mean annual total costs (combining direct costs and productivity costs for subjects of employment age) was $20,924. "SLE imposes a considerable financial burden, not only because of the health care resources that are consumed in the management of this complex disease, but also because of the loss of productivity due to work disability, explains Pantelis Panopalis, MD; assistant professor of medicine; McGill University Health Centre, Montreal, Quebec, Canada, and lead investigator in the study."The hope is that efforts to improve the care and treatment of persons with SLE will improve outcomes and help offset these considerable personal and societal costs."

The ACR is an organization of and for physicians, health professionals, and scientists that advances rheumatology through programs of education, research, advocacy and practice support that foster excellence in the care of people with or at risk for arthritis and rheumatic and musculoskeletal diseases. For more information on the ACR's annual meeting, see www.rheumatology.org/annual.

Editor's Notes: Dr. Panopalis will present this research during the ACR Annual Scientific Meeting at the Moscone Center from 10:30 " 10:45 AM on Wednesday, October 29, in the Moscone Center.

Dr. Panopalis is currently at McGill University Health Centre; however, this research was performed when Dr. Panopalis was a research fellow at the University of California, San Francisco, in San Francisco, Calif.

Presentation Number: 2064

Healthcare Costs And Costs Associated With Changes In Work Productivity Among Persons With Systemic Lupus Erythematosus

Pantelis Panopalis, Jinoos Yazdany, Joann Zell Gillis, Laura Julian, Laura Trupin, Aimee Hersh, Lindsey Criswell, Patti Katz, Ed Yelin. University of California, San Francisco, San Francisco, CA

Objective: To estimate healthcare costs and costs associated with changes in work productivity in persons with systemic lupus erythematosus (SLE).

Methods: Data were derived from a large cohort of individuals with SLE from the United States who undergo annual structured telephone interviews. Participants provided information on their healthcare resource utilization and employment. Data regarding demographics, SLE symptoms and activity, health status, and medications were also obtained. Cost estimates were derived for both direct healthcare costs and costs related to changes in work productivity. Direct healthcare costs included costs for acute and chronic care hospitalizations, emergency department services, outpatient services by physicians and other health professionals, outpatient surgical procedures, dialysis, and medications. Productivity costs were estimated by measuring changes in hours of work productivity since diagnosis of SLE; these estimates were also compared to normal US population data.

Results: A total of 812 subjects were included in the analysis. The majority of subjects were female (92.6%) and Caucasian (74.0%). The average age at the time of the interview was 48.2 years and the average disease duration was13.7 years. For the total population of participants, the mean annual direct healthcare cost was $12,643 (2004 US dollars). Acute care hospital admissions accounted for almost half of all direct healthcare costs (48.7%), resulting in an average annual cost of $6,153 per participant. A quarter of costs were due to medications (25.7%), resulting in an annual average cost of $3,244, and 11.6% of costs resulted from outpatient visits to physicians($1,465). The mean annual productivity cost for subjects of employment age (≥18 and <65) was $8,659 (Table 1). The mean annual total cost (direct and productivity) for subjects of employment age was $20,924. Regression results showed that greater disease activity, longer disease duration, and worse physical and mental health were significant predictors of higher direct costs; greater age predicted lower direct costs. Greater age, greater disease activity, and worse physical and mental health status were significant predictors of higher costs due to changes in work productivity.

Conclusions: Both direct healthcare costs and costs associated with changes in work productivity are substantial and both represent important contributors to the total costs associated with SLE. There is a considerable increase in both direct healthcare costs and productivity costs with greater disease activity.Work productivity at year of diagnosis and current year for employment-age participants National Average* LOS participants: Diagnosis year (n=651) LOS participants: Current Year (n=651) Change(current year - diagnosis year)Employment status Employed**, % 75.3% 76.8% 48.7% -28.1%Labor force activity Hours per week 27.0 30.8 (20.6) 19.1 (20.8) -11.7 (25.4)Weeks per year 33.8 33.7 (21.9) 24.6 (24.6) -9.1 (28.8)Hours per year*** 1270.2 1378.2 (1045.4) 899.5 (1047.6) -478.6 (1264.8) Estimated annual income, in 2004 USD (SD) $22,978.68 $24,931(18911) $16,273(18951) -$8,659(22880)*Based on data derived from the Current Population Survey for women aged 25 to 54; **Had a job or did any work for pay or profit; ***'Hours per year' is a calculated variable and represents the product of 'hours per week' and 'weeks per year'

Disclosure Block: P. Panopalis, None; J. Yazdany, None; J. Gillis, None; L. Julian, None; L. Trupin, None; A. Hersh, None; L. Criswell, None; P. Katz, None; E. Yelin, None.


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